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2026年全國醫(yī)學英語水平考試（METS四級）考前沖刺試題及答案四,更多相關(guān)資訊請繼續(xù)查看易考吧全國醫(yī)護英語水平考試
1). (一)■Alternative Therapies■1In recent years millions of Americans have turned to chiropractic， acupuncture，homeopathy， biofeedback， visualization and crystal healing， as alternatives to conventional medicine， or have “mixed and matched” conventional therapy with other， seemingly incompatible healing options.In 1990， Americans made 388million visits to primary care physicians within the medical “establishment”一and425 million visits to providers of nonconventional therapies.The highest use of alternative approaches was reported by relatively well educated and affluent whites from 25 to 49 years of age.Alternative therapies can be divided into three basic categories：botanical healing， hands-on therapies， and mind-body techniques.Some schools of practice， such as naturopathy， macrobiotics， and Ayurvedic medicine (a 4，000-year-old Indian healing tradition) rely on more than one form and sometimes advocate changes in diet or exercise patterns as well.Some alternative practices are derived from mainstream： medicine as practiced in other parts of the world， while others stem from contemporary “New Age” thinking.■2 Alternative therapy， in fact， is reshaping conventional medicine.Some medical schools offer courses ，on nonconventional medical practices and have begun to reexamine techniques once dismissed as； quackery.It is not unusual to find traditional cancer therapy being supplemented by relaxation exercises and support groups， or to see studies in leading medical journals on the impact of yoga or biofeedback on coronary artery disease， or to encounter best-sellers written by prominent physicians about the influence of laughter or hope on the immune system.■3Many physicians question the more extravagant claims of alternative therapies.They warn that these practices， if not downright dangerous in their own right， may keep people from seeking effective treatment.But it is becoming harder to deny that at least some alternative techniques work for some patients一even if medical science cannot explain exactly how.Furthermore， the growing acceptance of alternative therapies has led some critics of mainstream medicine to perceive it as the harbinger of a medical revolution.They predict that Western medicine someday will evolve from its narrow biochemical model to a “biopsychosocial”one that incorporates holistic thinking： a perception一sometimes regarded as a traditionally feminine one一that the body is an integrated unity and that emotional， spiritual， social， and environmental factors are as crucial in determining illness as physical trauma or biochemical events.While acknowledging that viruses play a role in inducing colds， alternative healers may also consider stress in the workplace， mental depression， and inadequate diet equally important.Before this century such thinking was common in conventional medicine.The fact that many traditional doctors have begun to reincorporate these ideas into their studies and practices reflects the success of alternative therapy advocates， as well as the frustration that many patients feel with conventional medical care.■4Conventional biomedicine has been particularly powerful in treating critical injuries and infectious diseases一broken arms or diphtheria， for example - and its stunning successes account for the relative decline in alternative therapies earlier in the twentieth century.But in recent decades， as many of our society′s pressing medical problems have shifted from infectious diseases to chronic conditions such as cancer， coronary artery disease， multiple sclerosis， back pain，and diabetes， biomedicine has been somewhat less effective.Critics， many of whom are baby boomers who grew up questioning authority， add that biomedicine has also been deficient in treating everyday ailments and in maintaining health..The holistic approach， with its emphasis on individual circumstances， provides an alternative for those patients who are frustrated by these limitations and by physicians who， they feel， regard them not as whole human beings but as body parts.■5Other people are attracted to alternative therapies because they deemphasize drugs， surgery， and technology.“Natural” approaches to good health such as herbs， lifestyle changes， healthful diets， massage and psychotherapy appeal to patients who want to participate more in their own health care.And in this age of exploding medical costs， few can afford to ignore the potential savings that may come from emphasizing wellness over disease and prevention over treatment-an emphasis common among alternative practitioner.■6 The most obvious distinctions between alternative and conventional care are less emphasis on well- defined educational standards required of practitioners；an emphasis on holistic or biopsychosocial explanations for illness， in contrast with the biomedical model that underlies conventional medicine； and different standards of scientific proof.■7Whereas a few successful cases may “prove” the efficacy of a therapy to an alternative healer， medical scientists disregard such anecdotal evidence.They argue that a certain number of patients are bound to get well with or without treatment.Studying just a few cases leaves open the possibility that the “cure” was the result of blind chance or the placebo effect一a phenomenon in which the patient′s belief that she is being treated effectively is enough to make the treatment actually work.The gold standard in conventional medicine is the clinical trial -a randomized study of comparable groups of patients， some of whom receive the treatment being studied and some of whom receive an inactive placebo.In“double-blind” clinical trials， neither the patients nor the health care providers administering either therapy or placebo know which patients are receiving what until the results are revealed at the end of the study.Only this kind of controlled trial can rule out the effects of chance， from the point of view of conventional research.■8 From the holistic perspective， by contrast， traditional diseases are merely the symptoms of underlying spiritual or natural imbalances， which can vary from individual to individual.This explains why some alternative healers advocate remedies that have been disproved by large -scale clinical trials： if each patient′s experience of illness is a product of individual diet， lifestyle， history， mental state， and so on， then a treatment that works for one sick person does not necessarily work for another， and certainly might not work for a whole group of people in a randomized trial.Alternative practitioners argue that they treat the underlying cause of disease， while conventional medicine treats only its symptoms.Conventional medicine counters by claiming just the opposite， since biomedicine regards the true causes of disease， whether physical or emotional， to be the bacteria， tumors，biochemical imbalances， physical trauma， and the like that they study in their clinical trials.■(二)■During these decades， alternative therapies (chiropractic， acupuncture， homeopathy，biofeedback， visualization， crystal healing， etc.) have become one of the healing options of millions of Americans.The offer of ( ) medical practice courses from some medical schools indicates that alternative therapy is rebuilding conventional medicine.The increasing ( )of alternative therapies has led some critics of mainstream traditional medicine to perceive it as the forerunner of a medical( ) Conventional biomedicine becomes less effective confronting certain( )diseases.Further， traditional drug， surgery and technology are not( )by patients.Alternative practitioners claim that contrary to traditional biomedicine， they cure the underlying cause of disease， other than symptoms.Consensus is never ( ) .( )
A.advocated
B.recognition
C.argued
D.reached
E.symptoms
F.nonconventional
G.individual
H.emphasized
I.chronic
J.regulations
A.artificial
A.reform

正確答案：I
2). 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 4 ( )
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：G
3). 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.( )
A.autoimmune
B.atypical
C.variety
D.deficiency
E.diagnosis
F.gold
G.gluten
H.diet
I.reliable
J.endoscopy
A.abnormal
A.normal

正確答案：F

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