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2023年全國醫(yī)學英語水平考試（METS四級）考前沖刺試題及答案五,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). 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.Which statement is NOT TRUE about question banks?( )
A.They offer exam- styled exercises
B.They can be assessed through mobile phones
C.They include high-level cognitive tasks
D.They do not include questions about definition and understanding

正確答案：D
2). (一)■Allergies Are on the Rise， but So Are Treatments■1Environmental allergies are becoming more prevalent and are not likely to recede any time soon.Treatment options， though， are expanding and improving，giving internists and allergists a wide range of therapy options.According to the American College of Allergy， Asthma， and Immunology， allergies are the sixth leading cause of chronic illness in the U.S.， with an annual cost of around$18 billion.One in 5 Americans have some kind of allergy， many of which are environmental in nature.The Centers for Disease Control and Prevention estimates that the rate of asthma in the United States grew 28% from 2001 to 2011 .Allergy sufferers are more likely to develop asthma， and allergic asthma is the most common form of the condition， accounting for more than half of cases.The most common allergic asthma triggers are environmental and include seasonal pollen， dust mites， pet dander， and cockroaches.■2“The prevalence seems to be increasing，” said Rohit K.Katial， MD， FACP，a professor of medicine， co-director of The Cohen Family Asthma Institute，and director of the allergy and clinical immunology fellowship at the National Jewish Health medical center in Denver.“There are all sorts of theories for this.”Although there is no clear cause， a sprawling blend of societal changes may be driving up pollen counts and human sensitivity.Perhaps the most prominent theory， allergies said， is the so-called hygiene hypothesis， which posits that over-sanitization reduces everyday bacterial exposures and makes one more likely to develop allergies early in life.Modern home weatherproofing exacerbates the situation by sealing occupants against the outdoors and increasing exposure to indoor allergens.On the other end of the hypothetical spectrum， pollen may be more widespread because of climate change.Warmer temperatures lead to increased pollen counts and longer allergy seasons.■3The symptoms most frequently associated with hay fever or allergic rhinitis -sneezing， runny nose， nasal congestion， itchy or watery eyes - are familiar.But they are not the only ones.According to John Kelso， MD， an allergist /immunologist managing allergies begins with the patient history.“Ask if a symptom appears to be seasonal or if there are any particular triggers，” Dr.Kelso said.“If either of those is true， it′s more likely to be allergic rhinitis.” He also noted that allergic shiners， or dark circles under the eyes， while not always caused by allergies， may be a tipoff， as can itching in the palette or ears.Oral allergy syndrome， characterized by itching or swelling in the mouth or throat after patients eat certain fresh fruits or vegetables， can also be a giveaway.This syndrome represents cross -reactivity of proteins in some raw fruits and vegetables and those of specific pollens.The food-related symptoms can tip physicians off to an associated pollen allergy.■4 Just as environmental allergies arise from various factors， so， too， is there a wealth of treatment combinations.Some therapeutic options are tried and true.Others are more novel.The cornerstone of treatment remains the simplest， almost to the point of tautology： Fighting environmental allergies begins with the environment.Environmental control strategies vary by allergen.A pet dander allergy， for example， means bathing pets regularly， keeping them out of bedrooms， and using filters in vacuum cleaners and heating and air conditioning systems that meet the high-efficiency particulate arrestance (HEPA) standard.Dust mite allergies mean using hot water to wash bedding and allergen-proof cases for pillows and mattresses.A more fluid part of the treatment equation is the spectrum of available medication.■5 Over-the- counter corticosteroid nasal sprays and antihistamines remain popular.Nasal corticosteroids help with congestion and inflammation； antihistamines address runny nose， sneezing， and itching.“A relatively new entry into the field is topical antihistamine nasal sprays，” Dr.Kelso said.“You can take these if you don′t get enough relief from the nasal corticosteroid spray alone.” Some manufacturers combine corticosteroid and antihistamine into 1 nasal spray.This can deliver relief and convenience， but is usually more costly than purchasing each medication separately and combining them at home with a physician′s guidance， Dr.Kelso noted.Because many allergy medications (both over- the-counter and prescription)have the same or similar formulations， Dr.Kelso recommends those that are least expensive， depending on patient insurance status.■6 One of the most effective treatment options is allergen immunotherapy.Almost anyone， including children and adults， is eligible to receive the injections， and efficacy is high.(The American Academy of Allergy， Asthma， and Immunology does not typically recommend allergy shots for children younger than 5， and older adults may require closer oversight because of various potential conditions，including heart disease.) Another， newer immunotherapy iteration is also emerging.In 2014， the U.S.Food and Drug Administration approved sublingual immunotherapy (SLIT) allergy tablets， which administer allergy medications under the tongue， rather than via injections.So far， the FDA has approved SLIT treatments for grass and ragweed pollens.■7The first dose must be taken at a clinician′s office， where the patient remains for at least 30 minutes in case of potential adverse reactions.One of the downsides to immunotherapy injections is the time commitment involved.Because of a small but real risk of anaphylactic shock， patients wait 30 minutes in the physician′s office after the injection.Patients typically receive 2 injections a week for 3to 6 months， then monthly maintenance doses for about 5 years.“Shots are exceedingly effective，” Dr.Kelso said.“For people with typical hay fever， the overwhelming majority has complete or near complete relief with those.People can still continue with oral medicines in addition to the shots， but the shots work so well they often don′t need to take any more medicine.”■8 According to a 2011 practice parameter published by the American Academy of Allergy， Asthma， and Immunology， “the physician′s office should have the expertise， personnel， and procedures in place for the safe and effective administration of immunotherapy…A physician or qualified physician extender(nurse practitioner or physician′s assistant) should be present and immediately available and be prepared to treat anaphylaxis when immunotherapy injections are administered.Regular practice drills with the office staff for handling systemic reactions to immunotherapy reactions should be considered.” “It all boils down to quality of life，” Dr.Castells said.“If a primary care physician can manage symptoms with a steroid and over-the-counter medication， you may not need an allergist.If a patient is waking up in the middle of the night or can′t go to the park and play with their kids or do sports despite medication， they may need to be seen by an allergist.”■(二)■Allergies are the sixth leading cause of chronic illness in the U.S.， with an annual cost of around $18 billion and the prevalence seems to be increasing.Although there is no clear cause， the most prominent theory is the so-called hygiene hypothesis which( ) .that over-sanitization reduces the chance of ( )to bacteria.Hay fever or allergic rhinitis are the most frequent symptoms， but for oral allergy syndrome and the food-related symptoms seem to be different.■Corticosteroid and antihistamine are popular to be seen in nasal sprays respectively，which are useful for congestion and( )，runny nose， sneezing， and itching.One of the most effective treatment options is allergen immunotherapy.Both children and adults are ( )which is almost for everyone with high efficacy.But the disadvantage of immunotherapy injections is the time ( )involved.There is an argument that if a primary care physician can manage symptoms with a steroid and over-the-counter medication， you may not need an ( ).( )
A.allergist
B.exacerbates
C.triggers
D.eligible
E.inflammation
F.spectrum
G.specific
H.commitment
I.posits
J.anaphylactic
A.exposures
A.expertise

正確答案：K
3). “Scientists say they now have a near-perfect picture of the genetic events that cause breast cancer.The study， published in Nature， bas been described as a milestone′ moment that could help unlock new ways of treating and preventing the disease.” This citation is an episode from a health news report from BBC.What do you think of the news report， and do you agree with the view? Give your reasons.Your essay should not be less than 200 words.Create a title for your essay.

正確答案：Genetic Mutations Are Partial to Cancer■Recently， a new study is said to be a milestone in cancer research and of special concern because researchers in the study say they have a nearly complete view of the role of genetic mutation in breast cancer， hopefully leading to new ways of treating and preventing the disease.■Clearly， this new study， published in Nature， can add an important piece of information to reasons for breast cancer and add evidence of genetic mutational signature in some patients with the disease.However， it is widely accepted that genetic factors play only a partial role in the development of the disease.Other variables， such as a person′s lifestyle and environment， are also part of the equation and make it difficult to completely understand the pathogenesis and more difficult to develop new therapies.In fact， some patients with breast cancer are hereditary， but most are still unexplained.Thus， other variables should be taken into account when it comes to the treatment of breast cancer.■Furthermore， despite the fact that the time spent in putting advances in basic scientific research into practice shortens， it turns out that the road is still long and twisting.And it takes at least a decade to develop new drugs with new targets based on mutated genes and their proteins.What′s worse， it is well known that cancer cells are very crafty and they work out ways of developing resistance to new therapeutics.Therefore， whether this study can bring a breakthrough in terms of new therapy for breast cancer is still unknown in the field.■Personally， I am not so optimistic about the prospects of this study， but at least I hope the findings in the study could eventually lead to ways of reducing the risks of breast cancer.

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