内科学试卷(北医,可能是2002或2003年的)一．A型选择题（每题1分，共10分）1．目前有关1型糖尿病的正确描述是A.胰岛素依赖型糖尿病B.仅发生在青少年的糖尿病C.部分病人探查不到自身免疫标记物D.有胰岛素受体自身抗体存在E.与一些遗传性疾病密切相关2．下列哪项心电图改变最能提示支持室性心动过速诊断A．心室率通常为100-250次/分；心律规则B．QRS波群形态畸形，时限超过0.12秒C．全部心前区导联QRS波群主波方向呈同向性D．QRS波群至逆传P波的间期≤0.10秒E．V1导联的QRS波呈RSR′型（三相波）3．关于血管紧张素II受体阻滞剂的叙述，下列哪项不正确．．．A．减轻水钠潴留B．抑制细胞增生C．不影响缓激肽水平D．不与血管紧张素转换酶抑制剂合用E．有效阻断血管紧张素对血管收缩的作用4．青年女性，腹痛、腹泻2个月入院。
腹痛位于右下腹，大便每日2-4次，糊状无脓血。
伴不规则发热、关节痛，偶有口腔溃疡。
结肠镜为回肠末端肠黏膜充血、水肿，溃疡形成，病理示干酪坏死性肉芽肿。
此患者可能的诊断是A．慢性阑尾炎B．白塞病C．Crohn病D．肠结核E．淋巴瘤5．下列哪项不能．．作为判别重症急性胰腺炎的指标A．动脉血氧分压<60mmHgB．血、尿淀粉酶均高于正常值20倍以上C．外周血白细胞>20×109/LD．无糖尿病史者血糖>11.2mmol/LE．血钙低于1.75mmol/L6．恶性高血压的诊断属于A．临床诊断B．病理诊断C．病因诊断D．肾功能诊断E．心功能诊断7．下列哪项能反映贮存铁水平A．血清铁蛋白B．血清铁C．总铁结合力D．原卟啉E．转铁蛋白8．传染病的确诊依据是A．临床表现B．流行病学资料C．血尿便常规检查D．病原学检查E．影象学检查9．下述用于治疗肺结核的药物中哪一种可能引起视力减退？A．链霉素B．异烟肼C．利福平D．乙胺丁醇E．吡嗪酰胺10．下列药物中哪一种可能引起肺间质纤维化？A．硝苯吡啶B．阿司斯匹林C．胺碘酮D．强的松E．氨茶碱11．血清阴性脊柱关节病是指血清中A．ANA阴性B．RF阴性C．ASO阴性D．CRP阴性E．dsDNA阴性二．填空题（每空1分，共20分）1．临床应用羟甲基戊二酸单酰辅酶A（HMG-CoA）还原抑制剂治疗高血脂症，主要可降低血（ 1 ）及（ 2 ）水平，同时亦降低（ 3 ）水平。
常用药物有（ 4 ）等。
2．溃疡性结肠炎病变最多位于（5）,一般累及（6）。
Crohn病病变最多位于（ 7 ）,一般累及（ 8 ）层。
3．急性链球菌感染后肾小球肾炎引起水肿的主要机制为（9 ），首选降压药物为是（10）。
4．溶血性贫血是（11 ），并（12 ）时所发生的一种贫血。
5．引起我国肾综合征出血热的汉坦病毒的两个型是（13 ）及（14 ）。
6．通常将（15 ）（16 ）和（17 ）归为非典型性肺炎。
共同特点是其致病微生物在（18 ）内繁殖，故常用大环内酯类药物治疗。
7．泌乳素瘤的体积一般（19 ）mm，主要表现为（20 ）。
8．类风湿关节炎临床表现为受累关节（21 ）功能下降，病变呈持续（22 ）过程。
三．名词解释（每题2分，共20分）1．浸润性突眼2．折返机制3．心室重构4．Zollinger-Ellison综合征5．肝肾综合征6．急进性肾小球肾炎7．ANCA8．弥散性血管内凝血9．医院内感染性肺炎10．过度通气四．必答问答题（每题5分，共30分）1．FAB协作组对MDS的分型意见。
2．如何正确指导病人准确留取24小时尿3．简述Ⅲ类抗心律失常药物的电生理效应。
以胺碘酮为例，简述其临床的应用（适应症选择、不良反应及其应用注意点）。
4．溃疡性结肠炎发生中毒性结肠扩张的机制、诊断及治疗原则？5．请简述系统性红斑狼疮患者肾活检的目的,肾脏病理肾小球的活动病变指标。
6．何谓慢性咳嗽？简述临床上可引起慢性咳嗽的常见疾病。
五．专业选答题（每专业选题共20分）内分泌1．老年甲状腺功能低下患者如何进行甲状腺激素替代治疗2．2型糖尿病患者使用胰岛素的方法心血管1．何为急性冠脉综合征？2．ACS的发病机理及导致发病的诱因是什么？3．目前针对ACS发病机制所采取的防治措施有哪些？消化1．简述胃癌的定义和分型。
肾脏1．请简述急性肾衰竭和慢性肾衰竭的鉴别诊断要点和急性肾衰竭的诊断思路。
血液1．列举3种细胞遗传学异常特征，并说明其与急性白血病临床的关系2．女性，17岁，重型（I型）再障患者，月经出血不止，经急诊入院，Hb 90g/L，WBC 2.3×109/L, Plt 7.0×109/L，请写出具体处置（治疗）意见传染1．为诊断乙型肝炎病毒感染，在血清中可检测哪些肝炎病毒标志物？各有什么意义？哪些项代表病毒复制？2．艾滋病的传播途径有哪些？目前常采用的抗病毒治疗是什么？判断疗效的二个重要指标是什么？呼吸1．临床上按照肺结核病变活动程度可将肺结核分为哪三期？2．述开放性肺结核和活动性肺结核的含义。
免疫1．1997年美国风湿病学会（ACR）公布的系统性红斑狼疮的诊断标准是什么？与1982年的标准有什么区别?专业英语试卷一．名词英译汉：（每题1分，共11分）1．toxic multinodular goiter2．idiopathic hypertrophic subaortic stenosis3．coronary angiography4．Hematemesis5．Polyposis syndrome6．Acute pyelonephritis7．Myelophthisic anemia8．encephalitis9．bronchial challenge test10．legionnaires disease11．polymyositis,二．名词汉译英：（每题1分，共11分）1．糖尿病视网膜病变2．心动过缓-心动过速综合征3．恶化型心绞痛4．胃食管反流病5．肠激惹综合征6．慢性肾小球肾炎7．血栓性血小板减少性紫癜8．败血症9．结核性胸膜炎10．呼吸机相关性肺炎11．人类白细胞抗原三．英译汉：（共58分）传染病：（共7分）To determine the safety and efficacy of ganciclovir treatment of hepatitis B virus (HBV) infection after liver transplantation, nine patients (seven males, two females; mean age, 38 years) with posttransplant HBV infection were treated with ganciclovir for 3 to 10 months. Ganciclovir was administered intravenously at an initial dose of 5 mg/kg/d and then increased to 10 mg/kg/d. Immunosuppressive drugs therapy was maintained at low levels. There were no major side effects of ganciclovir therapy. Serum HBV DNA levels decreased by a mean of 90% (range, 42% to 100%), and four of nine patients had no measurable HBV DNA at the completion of therapy. Mean serum alanine aminotransferase levels decreased by 83%. Hepatic expression of HBV antigens and HBV DNA was assessed before and after therapy in six patients and found to be reduced in three patients.内分泌：（共7分）Most patients with type 2 DM will eventually need insulin. Insulin therapy was started in patients with type 2 DM with a mean HbA1c level of 10.4 % in the United States, and the UKPDS showed that ß-cell failure is progressive; 50% of normalß-cell function at diagnosis with a steady decline following diagnosis. Concomitantly, 53% of patients with type 2 DM initially treated with Sus required insulin therapy by 6 years, and almost 80% required insulin by 9 years. Although we may be diagnosing DM earlier and thus altering this time frame, physicians should consider starting insulin therapy in patients whose HbA1c level approaches 8% despite optimal oral therapy.心血管：（共8分）While aspirin retains its status as the “front-lone” antiplatelet drug, the newer drugs now offer potentially greater and more specific control over platelet function. The blockade of the platelet glycoprotein IIb/IIIa receptor- the final common pathway to platelet aggregation- is effective in the setting of coronary angioplasty and is already being used widely in high-risk or complex angioplasty. It also appears likely that these drugs will be useful in acute coronary syndromes. The orally active ticlopidine has emerged as an effective alternative for patients intolerant of aspirin, and is superior to aspirin for secondary stroke prevention.Several more drugs are being developed, aimed at controlling different phases of platelet function, such as platelet adhesion.消化：（共8分）The gross morphologic features of adenocarcinoma in the large bowel depend on the tumor's site. Carcinomas of the proximal colon, particularly those of cecum and ascending colon, tend to be large and bulky, often outgrowing their blood supply and undergoing necrosis. This polypoid configuration may also be found elsewhere in the colon and rectum. In the more distal colon and rectum, tumors more frequently involve a greater circumference of the bowel, producing an annular constriction or "napkin-ring" appearance. The fibrous stroma of these tumors accouts for constriction and narrowing of the bowel lumen, whereas the circular arrangement of colonic lymphatics is responsible for their annular growth. These tumors may also become ulcerated.肾脏：（共7分）Blood urea is a poor guide to renal function as it varies with protein intake, liver metabolic capacity and renal perfusion. Creatinine is a more reliable guide as it is produced from muscle at a constant rate and almost completely filtered at the glomerulus. As very little creatinine is secreted by tubular cells the creatinine clearance provides a reasonable approximation of the glomerular filtration rate. If muscle mass remains constant, changes in creatinine concentration reflect changes in GFR. However, an increase outwith the normal range is not seen until GFR is reduced by about 50%, and isolated measurements of creatinine give a misleading impressionof renal function in those with unusually small amounts (and occasionally in those with very large amounts) of muscle.血液：（共7分）Essential monoclonal gammopathy is seen with increasing frequency in the elderly. In a Swedish study of 6,995 individuals over 25 years of age, 64 had a monoclonal protein in the immunoglobulin region on serum electrophoresis. One patient had frank multiple myeloma, and one had chronic lymphocytic leukemia. Eleven years later these two patients had died, and one other developed malignant lymphoma and died. Sixty-one patients had persistent monoclonal gammopathy. Other studies indicate that about 2 percent of patients with monoclonal gammopathy progress to malignant disease each year. The rate of occurrence of monoclonal gammopathy itself is 2 to 4 percent in the eighth decade, 6 to 12 percent in the ninth decade, and over 14 percent in the tenth decade of life.呼吸：（共7分）The Ministry of Health has fired up its anti-smoking campaign by pushing healthcare providers-particularly general practitioners-to take on an aggressive five-step plan to help smokers kick the habit.Dubbed the “5As approach ”,the plan was formulated by a workgroup of primary care doctors, health educators, specialists and others , and launched as part of the ministry’s brand-new set of clinical practice guidelines on smoking cessation. The “5As”consist of asking, advising, assessing, assisting and arranging.The first step involves getting family physicians and other healthcare providers such as dentists, nurses, psychologists and pharmacists to implement an office system where every patient is asked about their tobacco use at every visit.免疫：（共7分）Headache is a common symptom in the normal population, with an estimated point prevalence of 20 percent; whether there is a unique lupus headache is debated. From a practical standpoint, in a patient with lupus and headache, the important thing is to exclude other treatable causes and to not miss an infection, stroke, tumor, or drug-induced cause. An acute headache that is not severe and with no localized neurological signs and symptoms can be treated empirically and the patient observed. A severe headache, with neurological signs or symptoms, or chronic refractory course should prompt an MRI or CT of the brain, spinal fluid studies, and coagulopathy screen. Migrainous phenomenon may occur as a manifestation of active disease or may herald a flare.。