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2026年全國醫(yī)學(xué)英語水平考試（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)查看易考吧全國醫(yī)護(hù)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 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
2). Innovation in Medical Education■Our nation′s lack of research in medical education contrasts starkly with the large and essential commitment to biomedical research.No one questions the need for sustained support for research in cancer， heart disease， or dementia， But despite medical education′s central role in creating a workforce capable of delivering the resulting biomedical advances， funding for medical education research is conspicuously absent.( )■The current duration， settings， and organization of graduate medical education(GME) are more the product of tradition than of evidence and have changed little in the face of substantial changes in the health needs of patients and the systems for delivering care.We face questions about the most appropriate structure and content for GME， along with questions that extend beyond GME： What should change in undergraduate medical education， and how should we ensure the continued competence of physicians 20 to 30years into practice? ( )whether and how to support the education of other clinicians (in addition to physicians)， and to what extent federal GME funding is an effective or appropriate tool for addressing imbalances in the geographic or specialty distribution of health care providers.■The research that could answer these questions requires funding and organization that don′t currently exist.The Centers for Medicare and Medicaid Services pay about $ 10billion a year toward GME but have neither a research and development budget to ensure that this investment is achieving their objectives nor even a clear definition of what those objectives are.Overall， the United States spends nearly $ 3 trillion a year on health care，nearly all of it delivered through clinicians， with no organized research investment directed at improving the way those clinicians are produced.( )The fund would be directed toward research and innovation in the substance of GME as well as its organization and financing， and the proposal echoes the recommendations of other consensus reports.The committee also proposed a governance mechanism to set research priorities and coordinate large scale efforts such as multi-institutional studies or nationwide pilot programs.We propose the following approach，■First， valid and feasible measures of training success need to be defined.The fundamental goal of medical training is the production of a workforce capable of delivering economically sustainable care that will improve the health of patients and populations in a changing environment.( )Medical education is currently assessed through process measures (whether residents get enough cases， enough lectures， enough sleep) or intermediate outcomes such as exam performance.Although competency assessment is receiving increased attention， the connections between resident competency and patient outcomes are assumed rather than demonstrated.In order to evaluate alternative processes of medical education， we need systems for routinely assessing meaningful outcomes； the quality，distribution， and cost of care.Outcomes driven approaches have the additional advantage of fostering innovation.■Second， we need to examine fundamental changes to the structure and content of medical education.Optimal approaches for medical training may differ dramatically from current practice.With meaningful outcomes measures in hand， we can examine more fundamental questions， such as whether graduation from medical school or residency training should be time based or competency-based.( )Indeed， the increasing availability of medical information at the point of care might allow us to reduce the time and cost of creating new physicians and redirect some resources toward keeping the practices of established physicians current.■Third， new models for financing medical education could be piloted.One reason that GME gets so much attention is that a lot of money flows through it.Currently， medicare(mostly) pays hospitals (mostly) for training residents (exclusively physicians)，using a historical formula that is largely untethered to current goals.( )Innovative funding experiments could include allowing some residents (perhaps defined by specialty or institution) to bill for their services instead of having their institutions receive federal GME funding.Other experiments might assess the effect of using larger payments to direct trainees toward undersupplied specialties or geographic areas.Pilot programs might also distribute support across undergraduate， graduate， and continuing medical education - or to nonphysicians- potentially enhancing the leverage of public investment.■The fact that we lack evidence today doesn′t mean that we can′t have evidence for the education we will deliver or the policy changes we will need to make in 10 or 20 years.( )With some funding and an organized approach to research investment， we can innovate toward the future workforce we need.( )
A.But we need to start today if we want answers then
B.We also face active debate and a lack of evidence about how to better distribute financial support for GME，
C.Our system of medical education should be judged against those goals
D.We also need research that can inform decisions about the most useful mix of clinical training sites and the best ways to utilize the evolving capabilities of health information technology
E.As a result， we lack evidence that is essential for guiding improvements in the clinical workforce
F.Effective change requires that we develop and test better approaches
G.Which teaching strategies are best for delivering a curriculum that produces graduates who can efficiently serve the broad and changing needs of a diverse public
H.The Institute of Medicine committee has proposed “Transformation Fund” to fill this void

正確答案：A

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