2020考研英语一真题及答案【完整版】!【完形】Directions: Read the following text. Choose the best word (s) for each numbered blank and mark A, B, C or D on the ANSWER SHEET. (10 points)Even if families don't sit down to eat together as frequently as before, millions of Britons will nonetheless have got a share this weekend of one of that nation's great traditions: the Sunday roast. 1 a cold winter's day, few culinary pleasures can 2 it. Yet as we report now. The food police are determined our health. That this 3 should be rendered yet another quilty pleasure 4 to damage our health.The Food Standards Authority (FSA) has 5 a public worming about the risks of a compound called acrylamide that forms in some foods cooked 6 high temperatures. This means that people should 7 crisping their roast potatoes, reject thin -crust pizzas and only 8 toast their bread. But where is the evidence to support such adarmlist advice? 9 studies have shown that acrylamide can cause neurological damage in mice, there is no 10 evidence that it causes cancer in humans.Scientists say the compound is 11 to cause cancer but have no hard scientific proof 12 the precautionary principle it could be argued that it is 13 to follow the FSA advice. 14 it was rumourded that smoking caused cancer for years before the evidence was found to prove a 15Doubtless a piece of boiled feef can always be 16 up on Sunday alongside some steamed vegetables, without the York shire pudding and no wine. But would life be worth living? 17 ,the FSA says it is not telling people to cut out roast foods 18 , but rece their lifetime intake.However its 19 risks coming a cross as being pushy and overprotective. Constant health scares just 20 with no one listening.1. [A]In [B]Towards [C]on [D]Till2. [A ]match [B]express [C]satisfy [D]influence3.[A]patience [B]enjoyment [C]surprise [D]concem4.[A]intensified [B]privileged [C] compelled [D]guaranteed5. [A]issued [B]received [C]ignored [D]cancelled6. [A] under [B]at [C]for [D]by7. [A]forget [B]regret [C]finish [D] avoid8. [A]partially [B]regularly [C] easily [D]initially9. [A]Unless [B]Since [C]If [D]While10.[A] secondary [B]extermal [C] conclusive [D] negative11.[A]insufficient [B]bound [C]likely [D]slow12.[A]On the basis of [B]At the cost of [C] In addition to [D]In contrast to13.[A]interesting [B]advisable [C]urgent [D]fortunate14.[A]As usual [B]In particular [C]By definition [D]After all15.[A]resemblance [B]combination [C] connection [D]pattern16.[A]made [B]served [C]saved [D]used17.[A]To be fair [B]For instance [C]To be brief [D]In general18.[A]reluctantly [B]entirely [C] graally [D] carefully19.[A] promise [B] experience [C]campaign [D] competition20.[A]follow up [B]pick up [C] open up [D]end up答案(1-20)1. on2. match3. enjoyment4. intensified5. issued6. at7. avoid8. easily9. while10. conclusive11. bound12. on the basis of13. advisable14. after all15. connection16. served17. to be fair18. entirely19. campaign20. end up【阅读】Section III Reading ComprehensionPart A Directions: Read the following four texts. Answer the questions below each text by choosing A, B, C or D. Mark your answers on the ANSWER SHEET. (40 points)Text 1A group of labour MPs, among them Yvette Cooper, are bringing in the new year with a call to institute a UK "town of culture" award. The proposal is that it should sit alongside the existing city of culture title, which was held by Hull in 2017 and has been awarded to Coventry for Zozl. Cooper and her colleagues argue that the success of the crown for Hull, where it brought in220m of investment and an avalache of arts, out not to be confined to cities.Britain' town, it is true are not prevented from applying, but they generally lack the resources to put together a bit to beat their bigger competitions. A town of culture award could, it is argued, become an annual event, attracting funding and creating jobs.Some might see the proposal as a boo by prize for the fact that Britain is no longer be able to apply for the much more prestigious title of European capital of culture, a sought-after award bagged by Glasgow in 1990 and Livorpool in 2008. "A cynic might speculate that the UK is on the verge of disappearing into an endless fever of self-celebration in its desperation to reinvent itself for the post-Brexit world: after town of culture, who knows that will follow-village of culture? Suburb of culture? Hamlet of culture?It is also wise to recall that such titles are not a cure-all. A badly run "year of culture"washes in and out of a place like the tide, bringing prominence for a spell but leaving no lasting benefits to the community. The really successful holders of such titles are those that do a great deal more than fill hotel bedrooms and bring in high-profile arts events and good press for a year. They transform the aspirations of the people who live there; they nudge the self-image of the city into a bolder and more optimistic light.It is hard to get right, and requires a remarkable degree of vision, as well as cooperation between city authorities, the private sector, community groups and cultural organisations. But it can be done: Glasgow's year as European capital of culture can certainly be seen as one of complex series of factors that have turned the city into the power of art, music and theatre that it remains today.A "town of culture" could be not just about the arts but about honouring a town's peculiarities-helping sustain its high street, supporting local facilities and above all celebrating its people and turn it into action.21. Cooper and her colleagues argue that a "town of culture" award could [A] consolidate the town-city ties in Britain.[B] promote cooperation among Britain's towns.[C] increase the economic strength of Britain's towns.[D] focus Britain's limited resources on cultural events.22. According to Paragraph 2, the proposal might be regarded by some as [A] a sensible compromise.[B] a self-deceiving attempt.[C] an eye-cotching bonus.[D] an inaccessible target.23. The author suggests that a title holder is successful only if it [A] endeavours to maintain its image.[B] meets the aspirations of its people.[C] brings its local arts to prominence.[D] commits to its long-term growth.24. Glasgow is mentioned in Paragraph 3 to present [A] a contrasting case.[B] a supporting example.[C]a background story.[D] a related topic.25. What is the author's attitude towards the proposal?[A] Skeptical[B] Objective[C] Favourable[D] Critical答案(21-25)21.D focus Britain's limited resources on cultural events.22.B a self-deceiving attempt.23.D commits to its long-term growth.24.B a supporting example.25.C Favourable.Text2Scientific publishing has long been a licence to print money, Scientists need journals in which to publish their research, so they will supply the articles without monetary reward. Other scientists perform the specialised work of peer review also for free, because it is a central element in the acquisition of status and the proction of scientific knowledge.With the content of papers secured for free, the publisher needs only find a market for its journal. Until this century, university libraries were not very price sensitive. Scientific publishers routinely report profit margins approaching 40% on their operations, at a time when the rest of the publishing instry is in an existential crisis.The Dutch giant Elsevier, which claims to publish 25% of the scientific papers proced in the world, made profits of more than f 900m last year, while UK universities alone spent more than f 210m in 2016 to enable researchers to access their own publicly funded research;both figures seem to rise unstoppably despite increasingly desperate efforts to change them.The most drastic, and thoroughly illegal, reaction has been the emergence of Sci-Hub, a kind of global photocopier for scientific papers, set up in 2012, which now claims to offer access to every pay walled article published since 2015. The success of Sci-Hub, which relies on researchers passing on copies they have themselves legally accessed, shows the legal ecosystem has lost legitimacy among its users and must be transformed so that it works for all participants.In Britain the move towards open access publishing has been driven by funding bodies.In some ways it has been very successful. More than half of all British scientific research is now published under open access terms; either freely available from the moment of publication,or pay walled for a year or more so that the publishers can make a profit before being placed on general release.Yet the new system has not worked out any cheaper for the universities. Publishers have responded to the demand that they make their proct free to readers by charging their writers fees to cover the costs of preparing an article. These range from around500 to $5,000.A report last year pointed out that the costs both of subscriptions and of these "article preparation costs" had been steadily rising at a rate above inflation.In some ways the scientific publishing model resembles the economy of the social internet:labour is provided free in exchange for the hope of status, while huge profits are made by a few big firms who run the market places. In both cases, we need a rebalancing of power.26. Scientific publishing is seen as "a licence to print money" partly because [A] its funding has enjoyed a steady increase.[B] its marketing strategy has been successful.[C] its payment for peer review is reced.[D] its content acquisition costs nothing.!27. According to Paragraphs 2 and 3, scientific publishers Elsevier have [A] thrived mainly on university libraries.[B] gone through an existential crisis.[C] revived the publishing instry.[D] financed researchers generously.28. How does the author feel about the success of Sci-Hub? [A] Relieved.[B] Puzzled.[C] Concerned.[D] Encouraged.29. It can be learned from Paragraphs 5 and 6 that open access terms [A] allow publishers some room to make money.[B] render publishing much easier for scientists.[C] rece the cost of publication substantially.[D] free universities from financial burdens.30. Which of the following characterises the scientific publishing model?[A] Trial subscription is offered.[B] Labour triumphs over status.[C]Costs are well controlled.[D] The few feed on the many.答案(26-30)26.D its content acquisition costs nothing.27.A thrived mainly on university libraries.28.D Encouraged.29.A allow publishers some room to make money.30.D The few feed on the many.Text 3Progressives often support diversity mandates as a path to equality and a way to level the playing field. But all too often such policies are an insincere form of virtue-signaling that benefits only the most privileged and does little to help average people.A pair of bills sponsored by Massachusetts state Senator Jason Lewis and House Speaker Pro Tempore Patricia Haddad, to ensure "gender parity" on boards and commissions, provide a case in point.Haddad and Lewis are concerned that more than half the state-government board are lessthan40 percent female. In order to ensure that elite women have more such opportunities, they have proposed imposing government quotas. If the bills become law, state boards and commissions will be required to set aside 50 percent of board seats for women by 2022.The bills are similar to a measure recently adopted in Califomia, which last year became the first state to require gender quotas for private companies. In signing the measure, California Governor Jerry Brown admitted that the law, which expressly classifies people on the basis of sex, is probably unconstitutional.The US Supreme Court frowns on sex based classifications unless they are designed to address an "important" policy interest, Because the California law applies to all boards, even where there is no history of prior discrimination, courts are likely to rule that the law violates the constitutional guarantee of "equal protection".But are such government mandates even necessary? Female participation on corporate boards may not currently mirror the percentage of women in the general population, but so what?The number of women on corporate boards has been steadily increasing without government interference. According to a study by Catalyst, between 2010 and 2015 the share of women on the boards of global corporations increased by 54 percent.Requiring companies to make gender the primary qualification for board membership will inevitably lead to less experienced private sector boards. That is exactly what happened when Norway adopted a nationwide corporate gender quota.Writing in The New Republic, Alice Lee notes that increasing the number of opportunities for board membership without increasing the pool of qualified women to serve on such boards has led to a "golden skirt "phenomenon, where the same elite women scoop up multiple seats on a variety of boards.Next time somebody pushes corporate quotas as a way to promote gender equity,remember that such policies are largely self-serving measures that make their sponsors feelgood but do little to help average women.31.The author believes that the bills sponsored by Lewis and Haddad will [A] help little to rece gender bias.[B] pose a threat to the state government.[C] raise women's position in politics.[D] greatly broaden career options.32. Which of the following is true of the Califormia measure?[A] It has irritated private business owners.[B] It is welcomed by the Supreme Court.[C] It may go against the Constitution.[D] It will settle the prior controversies.33. The author mentions the study by Catalyst to illustrate [A] the harm from arbitrary board decision. [B]the importance of constitutional guarantees.[C] the pressure on women in global corporations.[D] the needlessness of government interventions.34. Norway's adoption of a nationwide corporate gender quota has led to [A] the underestimation of elite women's role[B] the objection to female participation on boards.[C]the entry of unqualified candidates into the board.[D] the growing tension between labor and management.35. Which of the following can be inferred from the text?[A] Women's need in employment should be considered.[B] Feasibility, should be a prime concern in policy making.[C] Everyone should try hard to promote social justice.[D] Major social issues should be the focus of legislation.答案(31-35)31.A help little to rece gender bias.32.C It may go against the Constitution.33.D the needlessness of government interventions.34.C the entry of unqualified candidates into the board.35.B Feasibility should be a prime concern in policymaking.Text4 :Last Thursday, the French Senate passed a digital services tax, which would impose an entirely new tax on large multinationals that provide digital services to consumers or users in France. Digital services include everything from providing a platform for selling goods and services online to targeting advertising based on user data, and the tax applies to gross revenue from such services. Many French politicians and media outlets have referred to this as a"GAFA tax," meaning that it is designed to apply primarily to companies such as Google,Apple, Facebook and Amazon-in other words, multinational tech companies based in the United States.The digital services tax now awaits the signature of President Emmanuel Macron, who has expressed support for the measure, and it could go into effect within the next few weeks.But it has already sparked significant controversy, with the Unite Sates trade representative opening an investigation into whether the tax discriminates against American companies,which in turn could lead to trade sanctions against France.The French tax is not just a unilateral move by one country in need of revenue. Instead,the digital services tax is part of a much larger trend, with countries over the past few years proposing or putting in place an alphabet soup of new international tax provisions. These have included Britain's DPT (diverted profits tax).Australia's MAAL (multinational antiavoidance, law), and India's SEP (significant economic presence) test, to name but a few. At the same time, the European Union. Spain,Britain and several other countries have all seriously contemplated digital services taxes.These unilateral developments differ in their specifics, but they are all designed to tax multinationals on income and revenue that countries believe they should have a right to tax,even if international tax rules do not grant them that right. In other words, they all share a view that the international tax system has failed to keep up with the current economy.In response to these many unilateral measures, the Organization for Economic Cooperation and Development (OECD) is currently working with 131 countries to reach aconsensus by the end of 2020 on an international solution. Both France and the United States are involved in the organization's work, but France's digital services tax and the American response raise questions about what the future holds for the international tax system.France's planned tax is a clear warning: Unless a broad consensus can be reached on reforming the international tax system, other nations are likely to follow suit, and American companies will face a cascade of different taxes from dozens of nations that will prove burdensome and costly.36.The French Senate has passed a bill to [A] regulate digital services platforms.[B] protect French companies interests.[C] impose a levy on tech multinationals.[D] curb the influence of advertising.37. It can be learned from Paragraph 2 that the digital services tax [A] may trigger countermeasures against France.[B] is apt to arouse criticism at home and abroad.[C] aims to ease international trade tensions.[D] will prompt the tech giants to quit France.38. The countries adopting the unilateral measures share the opinion that [A] redistribution of tech giants' revenue must be ensured.[B] the current international tax system needs upgrading.[C] tech multinationals' monopoly should be prevented.[D] all countries ought to enjoy equal taxing rights.39. It can be learned from Para 5 that the OECO's current work [A] is being resisted by US companies.[B] needs to be readjusted immediately.[C] is faced with uncertain prospects.[D] needs to in involve more countries.40. Which of the following might be the best title for this text?[A] France Is Confronted with Trade Sanctions[B] France leads the charge on Digital Tax[C] France Says "NO" to Tech Multinationals[D] France Demands a Role in the Digital Economy答案(36-40)36.C impose alevy on tech multinationals.37.A may trigger countermeasures against France.38.B the current international tax system needs upgrading39.C is faced with uncertain prospects.40.B France leads the charge on Digital TaxPart B Directions:In the following text, some sentences have been removed. For Questions 41-45, choose the most suitable one from the fist A-G to fit into each of the numbered blanks. There are two extra choices, which do not fit in any of the gaps. Mark your answers on ANSWER SHEET. (10 points)[A] Eye fix actions are brief[B] Too much eye contact is instinctively felt to be rude[C] Eye contact can be a friendly social signal[D] Personality can affect how a person reacts to eye contact[E] Biological factors behind eye contact are being investigated [F] Most people are not comfortable holding eye contact with strangers[G] Eye contact can also be aggressive.In a social situation, eye contact with another person can show that you are paying attention in a friendly way, But it can also be antagonistic such as when a political candidate turns toward their competitor ring a debate and makes eye contact that signals hostility.Here's what hard science reveals about eye contact: We know that a typical infant will instinctively gaze into its mother's eyes, and she will look back. This mutual gaze is a major part of the attachment between mother and child. In althood, looking someone else in a pleasant way can be a complimentary sign of paying attention. It can catch someone's attention in a crowded room, "Eye contact and smile" can signal availability and confidence, a common-sense notion supported in studies by psychologist Monica Moore.42. Neuroscientist Bonnie Augeung found that the hormone oxytocin increased the amount of eye contact from men toward the interviewer ring a brief interview when the direction of their gaze was recorded. This was also found in high- functioning men with some autistic spectrum symptoms, who may tend to avoid eye contact. Specific brain regions that respond ring direct gaze are being explored by other researches, using advanced methods of brain scanning.43. With the use of eye-tracking technology, Julia Minson of the Harvard Kennedy School of Government concluded that eye contact can signal very different kinds of messages,depending on the situation. While eye contact may be a sign of connection or trust in friendly situations, it's more likely to be associated with dominance or intimidation in adversarial situations. "Whether you' re a politician or a parent, it might be helpful to keep in mind that trying to maintain eye contact may backfire if you' re trying to convince someone who has a different set of beliefs than you," said Minson.44. When we look at a face or a picture, our eyes pause on one spot at a time, often on the eyes or mouth. These pauses typically occur at about three per second, and the eyes then jump to another spot, until several important points in the image. are registered like a series of snapshots. How the whole image is then assembled and perceived is still a mystery although it is the subject of current research.45. In people who score high in a test of neuroticism, a personality dimension associated with self-consciousness and anxiety, eye contact triggered more activity associated with avoidance,according to the Finnish researcher Jari Hietanen and colleagues "Our findings indicate that people do not only feel different when they are the centre of attention but that their brain reactions also differ." A more direct finding is that people who scored high for negative emotions like anxiety looked at others for shorter periods of time and reported more comfortable feelings when others did not look directly at them.答案(41-45)41. C Eye contact can be a friendly social signal42.E Biological factors behind eye contact are being investigated43.G Eye contact can also be aggressive44.A Eye fixactions are brief45.D Personality can affect how a person reacts to eye contactPart CDirections: Read the following text carefully and then translate the underlined segments into Chinese. Your translation should be written neatly on the ANSWER SHEET. (10points)Following the explosion of creativity in Florence ring the 14h century known as the Renaissance, the modern world saw a departure from what it had once known. It turned from God and the authority of the Roman Catholic Church and instead favoured a more humanistic approach to being. Renaissance ideas had spread throughout Europe well into the 17h century,with the arts and sciences flourishing extraordinarily among those with a more logical disposition. (46) with the Church's teachings and ways of thinking eclipsed by the Renaissance,the gap between the Medieval and modern periods had been bridged leading to new and unexplored itellectual territories.During the Renaissance, the great minds of Nicolaus Copernicus, Johannes Kepler and Galileo Galilei demonstrated the power of scientific study and discovery. (47) Before each of their revelations many thinkers at the time had sustained more ancient ways of thinking.including the geo-centric view that the Earth was a the centre of our universe. Copernicus theorized in 1543 that all of the planets that we knew of revolved not around the Earth, but the Sun, a system that was later upheld by Galileo at his own expense. Offering up such a theory ring a time of high tension between scientific and religious minds was branded as heresy and any such heretics that continued to spread these lies were to be punished by imprisonment or even death.(48) Despite attempts by the Church to suppress. this new generation of logicians and rationalists, more explanations for how the universe functioned were being made at a rate that the people could no longer ignore.It was with these great revelations that a new kind of philosophy founded in reason was born.The Church's long- standing dogma was losing the great battle for truth to rationalists and scientists. This very fact embodied the new ways of thinking that swept through Europe ring most of 17h century. (49) As many took on the ty of trying to integrate reasoning and scientific philosophies into the world, the Renaissance was over and it was time for a new era-the Age of Reason.The 17h and I8h centuries were times of radical change and curiosity, Scientific method,rectionism and the questioning of Church ideals was to be encouraged, as were ideas of liberty, tolerance and progress. (50) Such actions to seek knowledge and to understand what information we already knew were captured by the Latin phrase' sapere aude' or dare to know',after Immanuel Kant used it in his essay" An Answer to the Question: What is Enlightenment?".It was the purpose and responsibility of great minds to go forth and seek out the truth, which they believed to be founded in knowledge.答案(46-50)46.随着教会的教义和思维方式在文艺复兴时期黯然失色,中世纪与现代之间的鸿沟得以弥合,从而出现了新的及尚未开发的知识领域。47.在每个真理揭示之前,当时的许多思想家都采用了更古老的思维方式,仍旧沿用以前的思维模式,其中包括认为地球是宇宙中心的地球中心说。48.尽管教会试图镇压这-代逻辑学家和理性主义者,但人们对宇宙如何运转的解释却越来越多,并且以-种不容忽视的速度在增加。49.当许多人承担起将理性科学的哲学融入世界的责任时,文艺复兴时代已经结束,并且开启了一个新的时代。50.此类寻求知识和了解已知信息的行为被拉丁语概括为:“sapere aude"即"敢于求知”作文Section ll WritingPart A51. Directions:The students union of your university has assigned you to inform the international students about an upcoming singing contest. White a notice in about 100 words.Write your answer on the ANSWER SHEET.Do not use your own name in the notice. (10 points)小作文:通知留学生唱歌比赛 【参考范文】NoticeDec.21, 2019In order to enrich the campus life and provide the colorful life for you, the Students' Union is preparing the upcoming singing contest, which will be held in the auditorium in our university on the evening of December 31, 2019. Now, the Union is recruiting contestants for this competition.Anyone who are fond of signing or interested in the competition, please send his or her application to students’union@sohu.com before next Wednesday. Besides, there are generous awards in gratitude for this activity. Please do not hesitate to contact us if you have any queries concerning the singing contest. Meanwhile, volunteers for this activity are badly needed to assist us in organizing the relevant affairs.We are looking forward to your participation.The Students' UnionPart B52. Directions:Write an essay of 160-200 words based on the pictures below, In your essay, you should1) Describe the picture briefly,2) Interpret the implied meaning, and3) Give your comments.Write your answer on the ANSWER SHEET. (20 points)大作文:习惯良好的时间管理习惯 【参考范文】Portrayed distinctively by the two cartoons above is an impressive scene: a girl in the left picture is doing homework and saying that early completion is better. Nevertheless, the boy in the right picture is sitting in front of the desk and saying that he will not finish the homework until the last minute.Undoubtedly, the symbolic implication of the pictures is to show us that importance should be attached to the formation of good habits, especially the good habit of time management. On the one hand, efficient time management is critical to personal development. As the old saying goes,“Time is money," and in the fast-paced modern life, it seems that we always have a lot of things to do and we are very busy. In the face of such a situation, we have to realize that efficiency holdsthe key to saving time and time management skills hold the key to personal success. On the other hand, good time management habits play a vital role in the development of the whole society. There is no doubt that, to a large extent, social progress is closely related to the efforts of each indivial. If we can develop the good habit of time management, we are much more likely to improve efficiency and have a better performance in the learning and working process, which is anintegral part of social advances and prosperity.From what has been mentioned above, we can come to the conclusion that the sense of efficient time management skills is of equal importance in personal and social progress.Therefore,we ought to take advantage of the phenomenon to enlighten the public and the press is expected to take a lead in advertising the value of developing good time management habits. 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作为开场考试科目,2020政治考研真题结束了。大家关心的是,自己答对了几道2020政治考研真题主观题。其实,2020政治考研真题中的选择题也同样重要。选择题的正确率是取得高分的关键。接下来,跟文都考研网一起看看2020政治考研真题完整版吧。
初试定资格,复试定结果,虽然初试考试已经结束了,但是复试是第二关卡,不要掉以轻心哦,好好准备复试,等一切尘埃落定后,再去欢呼,再去放肆也不迟,现在还是要以大局为重,即便不知道成绩的情况下,积极准备复试也是一种经验的积累,万一过了复试线就用到了,加油吧。下面是2020考研数学一真题及答案解析,一起来看看吧。来源:文都(免责及版权声明:仅供个人研究学习,不涉及商业盈利,如有侵权请及时联系删除,观点仅代表作者本人,不代表本号立场)
2019年12月22日上午,2020考研数学考试已落下帷幕,刚出考场的考生是否对于2020考研数学一真题答案期盼已久呢?文都考研第一 时间带来了2020考研数学一真题及答案解析。以下是2020考研数学一真题完整版的内容,下面就跟随文都考研小编一起来看一看吧,了解一下自己的考试情况吧?数学一以上,就是文都考研给大家带来的2020考研数学一真题完整版内容,希望各位同学可以及时了解自己的考后情况。更多2020考研真题内容,请及时关注文都考研网。另外,2020考研考试期间,文都考研名师会同步带来2020考研真题解析视频直播,敬请关注。
2020考研已过,2021考研的小伙伴们准备开始啦,明年一年的复习计划你做好了吗?不以考上为目的的复习都是当炮灰,所以,计划需要早早准备,按计划来,一步步,稳扎稳打,考上研究生就胜券在握了。2020考研管理类联考真题及答案解析:来源:文都(免责及版权声明:仅供个人研究学习,不涉及商业盈利,如有侵权请及时联系删除,观点仅代表作者本人,不代表本号立场)
76、女性,60岁,1个月来与明显诱因心悸,呈发作性,持续1-2小时缓解,半小时前再次发作来院,近半年来自觉消瘦、乏力、出汗,食欲好,睡眠差、血压升高,查体体温37.3℃,BP140/70,皮肤出汗,颈部未闻及血管杂音,心界不大,心律不整,手颤(±),心室率136次/分,P波消失,可见形态不等f波,QRS波时限,0.08,间距不等。最可能诊断为什么病?【A】阵发性室上性心动过速【B】频发性房性早搏【C】阵发性房颤【D】阵发性房扑【答案】C【答案解析】因为P波消失代之以形态不规则的f波,且QRS波时限为0.08S(正常值为0.06~0.10秒),QRS波正常,所以该心率失常的类型为阵发性房颤(C对)。房室结折返性心动过速是阵发性室上性心动过速最常见的类型,心电图表现为出现逆行的P波,P波不消失也不出现f波,所以不是阵发性室上性心动过速(A错)。房性早搏即房性期前收缩的心电图特征为P波提前发生,与窦性P波形态不同但是P波不消失,所以和题干不符合(B错)。房扑的心电图特点为窦性P波消失,代之以振幅、间距相同的有规律的锯齿状扑动波,称为F波,所以与题干不符合,所以不是阵发性房扑(D错)。77、女性,60岁,1个月来无诱因感心悸,呈发作性,持续1~2小时可自行缓解,半小时前再次发作来院,近半年来自觉消瘦,乏力,出汗,食欲好,睡眠差,血压升高,查体:T.37. 2℃,P90次/分,BP140/70mmHg,皮肤出汗,颈部未闻及血管杂音,双肺正常,心界不大,心率不整,手颤(±)。心电图显示:心室率136次/分,P波消失,可见形态不等的f波,QRS波时限0.08",间距不等。产生的原因最可能为?【A】高血压【B】冠心病【C】糖尿病【D】甲状腺功能亢进【答案】D【答案解析】从题干中可以得知,该病人年龄为60岁,近半年消瘦、乏力、出汗、食欲好,所以考虑该病人患有甲状腺功能亢进,因为甲状腺功能亢进是心房颤动的好发因素,所以考虑该病人是甲状腺功能亢进(D对)引起的心房颤动。冠心病虽然也可以引起心房颤动,但是从题干中不能得出该患者患有冠心病(B错)。高血压(A错)和糖尿病(C错)一般不会引起心房颤动。78、女性,60岁,1个月来无诱因感心悸,呈发作性,持续1~2小时可自行缓解,半小时前再次发作来院,近半年来自觉消瘦,乏力,出汗,食欲好,睡眠差,血压升高,查体:T.37. 2℃,P90次/分,BP140/70mmHg,皮肤出汗,颈部未闻及血管杂音,双肺正常,心界不大,心率不整,手颤(±)。心电图显示:心室率136次/分,P波消失,可见形态不等的f波,QRS波时限0.08",间距不等。治疗基本是?【A】选用洋地黄类药物减慢心室率【B】行射频消融术转复心律【C】治疗原发病【D】临床观察【答案】C【答案解析】由于房颤的形成常是由于器质性心脏病,所以治疗房颤的关键在于治疗原发疾病(C对),从根本上治疗心房颤动的发生。心房颤动一旦发生应该积极治疗,不应该临床观察(D错)。洋地黄类的药物和射频消融术都可以减慢心室率,在治疗原发病的基础上可以使用,但是不是根本的治疗手段,即选用洋地黄类药物减慢心室率(A错)和行射频消融术转复心律(B错)不是最根本的治疗手段。79、男性,45岁,右季肋部胀痛伴厌食,腹胀1月余,既往患有乙型病毒性肝炎10余年。查体:肝右肋下3cm,质硬,边缘及表面不规则。目前最可能的诊断是【A】慢性重型肝炎【B】原发性肝癌【C】细菌性肝脓肿【D】肝脏血管瘤【答案】B【答案解析】患者中年男性(提示肝癌的好发年龄),既往患有乙型病毒性肝炎10余年(我国肝癌发病的最主要原因),右季肋部胀痛伴厌食,腹胀1月余(肝癌中晚期的全身表现),查体:肝右肋下3cm,质硬,边缘及表面不规则(提示肝大),目前最可能的诊断是原发性肝癌(B对)。80、男性,45岁,右季肋部胀痛伴厌食,腹胀1月余,既往患有乙型病毒性肝炎10余年。查体:肝右肋下3cm,质硬,边缘及表面不规则。实验室检查【A】血ALT和AST均升高【B】血AFP持续升高>400ng/ml【C】血ALT,AFP及白细胞计数均正常【D】血白细胞计数和中性粒细胞比例升高【答案】B【答案解析】患者中年男性(提示肝癌的好发年龄),既往患有乙型病毒性肝炎10余年(我国肝癌发病的最主要原因),右季肋部胀痛伴厌食,腹胀1月余(肝癌中晚期的全身表现),查体:肝右肋下3cm,质硬,边缘及表面不规则(提示肝大),诊断为原发性肝癌。原发性肝癌的实验室检查血AFP持续升高>400ng/ml(B对)。81、男性,45岁,右季肋部胀痛伴厌食,腹胀1月余,既往患有乙型病毒性肝炎10余年。查体:肝右肋下3cm,质硬,边缘及表面不规则。最有助于确定诊断检查的是【A】腹部B超【B】腹部CT【C】肝穿刺病理学检查【D】腹部动脉造影【答案】C【答案解析】患者中年男性(提示肝癌的好发年龄),既往患有乙型病毒性肝炎10余年(我国肝癌发病的最主要原因),右季肋部胀痛伴厌食,腹胀1月余(肝癌中晚期的全身表现),查体:肝右肋下3cm,质硬,边缘及表面不规则(提示肝大),诊断为原发性肝癌。最有助于确定诊断检查的是肝穿刺病理学检查(C对)。腹部B超目前肝癌筛查的首选方法(A错)。腹部CT可以更客观及更敏感地显示肝癌,1cm左右肝癌的检出率可>80%,是诊断及确定治疗策略的要手段(B错)。腹部动脉造影检查是肝痛诊断的重要补充手段(D错),对直径1-2cm 的小肝癌肝动脉造影可以更精确地作出诊断、正确率:90%。82、男,15岁,颜面、双下肢水肿,既往健。查体T36.5℃,BP120/70mmHg,眼睑肿,心肺未异常,腹平软,肝脾下未触及,下肢凹陷性水肿(++),化验尿蛋白(++++),沉渣镜检红细胞0-2个/Hp,血白蛋白25g/L,血胆固醇8mmol/L,血Cr102mmol/L,血BUN10.5mmol/L。该患者最可能的疾病【A】急性肾小球肾炎【B】急进性肾小球肾炎【C】肾病综合征【D】慢性肾小球肾炎急性发作【答案】C【答案解析】15岁青少年男性患者,既往健,查体T36.5℃、BP120/70mmHg均正常,也无心肺及肝脾异常。颜面、眼睑肿,下肢凹陷性水肿(++),化验尿蛋白(++++),血白蛋白25g/L(正常值35-55g/l),血胆固醇8mmol/L(正常值<5.2mmol/L)(典型的水肿、大量蛋白尿、低白蛋白血症、高脂血症),尿沉渣镜检红细胞0-2个/Hp(正常值<3个/Hp),血Cr102mmol/L(正常值44-133umol/l),血BUN10.5mmol/L(正常值3.2-7.1mmol/L),提示肾小球滤过率下降,综合该患者的病史、查体、实验室检查,该患者最可能的疾病是肾病综合征(C对)。急性肾小球肾炎(A错)(P466)临床特点为急性起病,表现为血尿、蛋白尿、水肿和高血压,可伴有一过性肾功能不全。急进性肾小球肾炎(B错)(P467)是在急性肾炎综合征基础上,肾功能快速进站,病理类型为新月体肾炎的一组疾病。慢性肾小球肾炎(D错)(P478)以蛋白尿、血尿、高血压和水肿为基本特点,起病方式各有不同,部分病人可因感染、劳累呈急性发作。83、男,15岁,颜面、双下肢水肿,既往健。查体T36.5℃,BP120/70mmHg,眼睑肿,心肺未异常,腹平软,肝脾下未触及,下肢凹陷性水肿(++),化验尿蛋白(++++),沉渣镜检红细胞0-2个/Hp,血白蛋白25g/L,血胆固醇8mmol/L,血Cr102mmol/L,血BUN10.5mmol/L。病理诊断为【A】毛细血管内肾小球肾炎【B】新月体型肾小球肾炎【C】系膜毛细血管性肾小球肾炎【D】微小病变型肾病【答案】D【答案解析】本题为15岁青少年男性患者,尿沉渣镜检红细胞0-2个/Hp。微小病变型肾病(D对)占儿童原发性肾病综合征的80%-90%,且本病男性多于女性,儿童发病率高,约15%的病人有镜下血尿。84、男,15岁,颜面、双下肢水肿,既往健。查体T36.5℃,BP120/70mmHg,眼睑肿,心肺未异常,腹平软,肝脾下未触及,下肢凹陷性水肿(++),化验尿蛋白(++++),沉渣镜检红细胞0-2个/Hp,血白蛋白25g/L,血胆固醇8mmol/L,血Cr102mmol/L,血BUN10.5mmol/L。最佳的治疗药物是【A】醋酸泼尼松【B】环磷酰胺【C】醋酸泼尼松联合环磷酰胺【D】辛伐他汀【答案】A【答案解析】微小病变型肾病90%的病例对糖皮质激素敏感,因此最佳的治疗药物是醋酸泼尼松(A对)。环磷酰胺(B错)是细胞毒药物,可用于“激素依赖型”或“激素抵抗型”的病人,协同激素治疗。若无激素禁忌,一般不作为首选或单独治疗用药。辛伐他汀(D错)为降脂药物。85、女性,18岁,乏力,面色苍白半年余,月经增多2年多。查体:贫血貌,巩膜无黄染,心肺未见异常,腹平软,肝脾肋下未触及。化验血常规:Hb80g/L,MCV65fl,MCH20pg,MCHC300,WBC4.0*10/L,Plt310*10/L。该病人最有可能的诊断是?【A】缺铁性贫血【B】地中海贫血【C】慢性病贫血【D】巨幼细胞贫血【答案】A86、女性,18岁,乏力,面色苍白半年余,月经增多2年多。查体:贫血貌,巩膜无黄染,心肺未见异常,腹平软,肝脾肋下未触及。化验血常规:Hb80g/L,MCV65fl,MCH20pg,MCHC300,WBC4.0*10/L,Plt310*10/L。为确诊,最有价值的检查项目是?【A】网织红细胞计数【B】铁蛋白检测【C】血红蛋白电泳【D】叶酸维生素B12检测【答案】C87、女性,18岁,乏力,面色苍白半年余,月经增多2年多。查体:贫血貌,巩膜无黄染,心肺未见异常,腹平软,肝脾肋下未触及。化验血常规:Hb80g/L,MCV65fl,MCH20pg,MCHC300,WBC4.0*10/L,Plt310*10/L。下列选项中可以明确贫血病因的是?【A】询问饮食情况及舌检查【B】询问既往患病史【C】询问详细月经情况及妇科检查【D】询问贫血家族史【答案】C88、女,60多岁,乏力,怕冷,嗜睡,既往有高血压病史。查体:T35.9 HR 80 BP 130/80(大概)。既往有心脏病史,叩诊心浊音界扩大,S1低钝。双下肢水肿,踝反射减低。该患者应首先考虑的疾病诊断是【A】甲状腺功能减退症【B】扩张性心肌病【C】结核性心肌炎【D】干燥综合征【答案】?89、女性,68岁,一个月来乏力,胃寒,胸闷,气短,记忆力明显减退,食欲差,夜间愿高枕卧位,既往因心律失常服用胺碘酮治疗,高血脂,关节痛史。入院查体:T35.9℃,心率84,BP100/85mmHg,高枕位,表情淡漠,皮肤干燥,睑结膜稍苍白,颈静脉充盈,甲状腺不大,双肺(—),心脏浊音界扩大,心律整,S1低钝,肝脾触诊不满意,双下肢凹陷性水肿(+),跟腱反射减退。为确诊,最有价值的具体检查是【A】ANT—proBNP【B】T—SPOT TB【C】TPOAb【D】抗ENA抗体【答案】?90、女性,68岁,一个月来乏力,畏寒,胸闷,气短,记忆力明显减退,食欲差,夜间愿高枕卧位,既往因心律失常服用胺碘酮治疗,有高脂血症,关节痛史。入院查体:T 35.9 p84次每分,血压100/85。高枕位,表情淡漠,皮肤干燥,睑结膜稍苍白,颈静脉充盈,甲状腺不大,双肺隐性,心浊音界扩大,心律整,第一心音遥远,肝脾触诊不满意,双下肢凹陷性水肿。跟腱反射迟钝,应选择的治疗是【A】口服糖皮质激素【B】口服左甲状腺素【C】口服利尿剂【D】抗结核治疗【答案】?91、女性,30岁,一个月来无明显诱因出现口、眼干燥,半个月来出现四肢关节疼痛,以肘、膝关节明显,一直未诊治。近几日来进固体食物须用水吞服,无多饮、多尿,大便正常。既往体健。查体:T36.8℃,血压120/80mmHg,舌体干燥,口腔异味大,心肺腹检查未见异常,肘、膝关节稍肿胀、轻压痛,下肢不肿。血常规:Hb 94g/L,RBC 3.1×10/L,WBC 3.5×10/L,PLT 126×10/L,该患者最可能的诊断是【A】干燥综合征【B】系统性红斑狼疮【C】类风湿性关节炎【D】糖尿病【答案】A【答案解析】干燥综合征(A对)的局部表现为口腔干燥症,干燥性角结膜炎,系统表现可出现发热乏力,肌肉关节痛等。系统性红斑狼疮(B错)是一种多发于青年女性的累及多脏器的自身免疫性炎症性结缔组织病典型表现为蝶形红斑、盘状红斑、关节痛等。类风湿性关节炎(C错)是一种病因未明的慢性、以炎性滑膜炎为主的系统性疾病。其特征是手、足小关节的多关节、对称性、侵袭性关节炎症,经常伴有关节外器官受累及血清类风湿因子阳性,可以导致关节畸形及功能丧失。糖尿病(D错)是一组以高血糖为特征的代谢性疾病,长期存在的高血糖,导致各种组织,特别是眼、肾、心脏、血管、神经的慢性损害、功能障碍。92、患者女,30岁,一个月前无明显原因出现口眼干燥。半个月前出现四肢关节疼痛,以双侧肘膝关节明显,未经诊治。近几天出现进食时需用水冲服,无多饮多尿,大便正常,既往体健。查体:体温36.8℃,血压120/80mmHg。舌体干燥,口腔异味大,心肺腹检查未见异常,肘、膝关节稍肿胀、轻压痛,下肢不肿。血常规:血红蛋白96g/l,红细胞3.1×10/L,WBC 3.5×10/L,PLT 126×10/L。最具有诊断意义的实验室检查是?【A】血清抗sm抗体【B】空腹血糖【C】血清RF【D】血清抗ssa,ssb抗体【答案】D【答案解析】根据题干口干症、眼干、关节痛等考虑诊断干燥综合征,干燥综合征特异性检查包括干燥性角结膜炎和口干症检测、血清抗SSA和(或)SSB抗体阳性(D对)、唇线组织病理学检查有灶性淋巴细胞浸润。抗Sm抗体(A错)属于抗核抗体的其中一种,其在系统性红斑狼疮病人血清中可被发现。抗Sm抗体是诊断系统性红斑狼疮的特异性抗体。空腹血糖(B错)为糖尿病最常用的检测指标,反映胰岛β细胞功能,一般表示基础胰岛素的分泌功能。类风湿因子(C错)是一种以变性IgG为靶抗原的自身抗体,无种属特异性。93、女性,43岁,1年来经常右上腹胀痛,有时出现黄疸,发热。外院发现胆总管扩张,并有结石。行胆囊切除术,胆总管探查术,取出结石1枚。术后3周行T管造影,结果显示:胆总管扩张,直径5cm,腔内未见明显结石,肝内胆管未见扩张,十二指肠影像正常,胰管显影,此结果提示【A】胆总管残余结石【B】胆总管下端肿瘤【C】正常胆道影像【D】先天性胆管扩张症【答案】C【答案解析】肝外胆管结石术后10~14天可行T管造影,如无结石及其他病变提示正常胆道影像(C对),胆总管残余结石(A错)常为胆管结石术后T管造影发现残余结石,需4~8周后继续治疗。胆总管下端肿瘤(B错)胆管癌是指原发于左右肝管汇合部至胆总管下端的肝外胆管恶性肿瘤,胆管造影常可发现病变。先天性胆管扩张症(D错)又称胆总管囊肿,是小儿较常见的胆道畸形,T管造影一般可发现畸形胆道。94、女性,43岁,近一年来右上腹胀痛,有时出现黄疸,发热。外院诊治发现胆总管扩张伴结石,行胆囊切除,胆总管探查术,取出结石一枚。术后3周T管造影示:胆总管扩张,直径约5cm,未发现明显结石,肝内胆管未见扩张,十二指肠显影正常,胰管显影。下列进一步治疗措施中,首选的是【A】胆道镜取石【B】whipple手术【C】肝外胆管切除,胆肠吻合术【D】拔出T管,继续观察【答案】C【答案解析】患者右上腹疼痛,伴发热黄疸,提示肝外胆管结石。外院诊治为胆总管结石并行胆囊切除术,肝总管探查术,取出结石一枚,术后3周T管造影示:胆总管扩张,直径约5cm,提示胆总管严重扩张(正常直径0.6~0.8cm),符合胆肠吻合术适应证,故应行胆肠吻合术。(C对)未发现明显结石,肝内胆管未见扩张,十二指肠显影正常,胰管显影,提示肝外胆管结石恢复尚好,无残留结石,肝内胆管无炎症和结石,十二指肠和胰管正常。95、患者女性,65岁。胆囊结石10年,近来反复发作胆绞痛,要求手术治疗。有高血压、糖尿病病史,服药血压维持在150~160/85~95mmHg,空腹血糖7.3mml/L。患者术前处理措施中正确的是【A】将血压降至130/90mmHg再手术【B】将血糖控制在6.1mmol/L再手术【C】将血压,血糖降至正常范围再手术【D】不需特殊处理,可手术【答案】D【答案解析】患者女性,65岁。胆囊结石10年,近来反复发作胆绞痛,提示胆囊结石症状加重。有高血压、糖尿病病史,服药血压维持在150~160/85~95mmHg(正常血压:100~120/60~80mmHg),空腹血糖7.3mml/L(成人空腹血糖:3.9~6.1mmol/L)。应行腹腔镜胆囊切除术,腹腔镜胆囊切除已是常规手术,具有损伤小、恢复快、疼痛轻、瘢痕不易发现等优点(D对)。96、患者腹腔镜胆囊切除,手术顺利。术后前3天引流管引流微黄清亮液体15-20ml/日,拔除引流管。术后10天患者自觉右上腹不适,来院。查体,T:37.2,WBC:9*10的9次方,N75%,B超示胆囊腋窝处4-5cm的液性暗区,穿刺抽出黄色液体似胆汁。最合适的处理是【A】穿刺置换引流【B】局部理疗【C】加用抗生素【D】手术引流【答案】A97、女性,52岁,结节性甲状腺炎诊断2年,一年后感觉颈部肿块增大,B超显示直径1.8cm增加到2.6cm,最可能的诊断【A】恶性变【B】囊内出血【C】亚急性甲状腺炎【D】桥本甲状腺炎【答案】A98、女性,53岁,诊断结节性甲状腺肿2年,近日突觉颈部胀痛,复查B超见左叶结节较1年前增大,直径由1.8cm变为2.6cm,成囊实性,部分囊壁可以片状钙化。目前最适宜的处理是【A】对症治疗【B】甲状腺大部切除术【C】穿刺引流【D】甲状腺结节切除【答案】D99、女,53岁,诊断为结节性甲状腺肿,近一年来颈部胀痛,复查显示,左侧腺叶呈囊性变,部分囊壁有钙化。近2年来复查,显示右侧腺叶出现钙化影,应采取的治疗做法【A】继续保守治疗【B】右侧腺叶全切,左侧腺叶部分切除【C】右侧腺叶切除【D】全腺叶切除【答案】B100、男性,62岁,因大便有脓血1月入院。肛门指诊在距肛缘7cm处触及大小4cm的肿物,中间有溃疡。活检病理:中分化腺癌。全身检查无阳性发现,肝肺未见转移。下列手术方案中最合适的是【A】乙状结肠造口术【B】Miles手术【C】Dixion手术【D】Hartmn手术【答案】C【答案解析】直肠癌根治性切除术术式分为Miles手术、Dixon手术、Hartmann手术及乙状结肠造口术,乙状结肠造口术为晚期直肠癌的姑息手术,以解除痛苦和处理并发症为主要目的,并不适用该题患者(A错)、Miles手术要求会阴部需切除部分肛提肌、坐骨肛门窝内脂肪、肛管及肛门周围约3~5cm的皮肤、皮下组织及全部肛管括约肌,该题患者肿物在距肛缘7cm处(B错)、Hartmann手术适用于一般情况很差,不能耐受Miles 手术或急性梗阻不宜行Dixon手术的病人,该题患者并未发生肠梗阻或一般状况差(D错)、该患者直肠肿瘤距肛缘7cm且一般状况可,未发生转移,宜采用Dixion手术根治切除(C对)。101、男,62岁,因有血便一个月入院,肛门指检在距肛缘7cm处触及直径4cm的肿物,中间有溃疡,活检病理,中分化腺癌。全身检查无阳性发现,囊肿未见转移。术后化疗五个疗程,2年后复查CT,发现右肝2个直径为2-3cm结节,边缘清晰,强化明显,呈“牛眼征”。最可能的诊断是?【A】直肠癌肝转移【B】原发性肝癌【C】肝多发血管瘤【D】多发肝囊肿【答案】A【答案解析】肝转移癌的原发肿瘤主要为结、直肠癌,该患者原发病为直肠癌,“牛眼征”为肝转移癌的超声表现,即肿瘤周边有较宽的低回声晕,内部为高回声或等回声,多见于腺癌(A对)。102、男,62岁,因有血便一个月入院,肛门指检在距肛缘7cm处触及直径4cm的肿物,中间有溃疡,活检病理,中分化腺癌。全身检查无阳性发现,囊肿未见转移。术后化疗五个疗程,2年后复查CT,发现左肝2个直径为2-3cm结节,边缘清晰,强化明显,呈“牛眼征”。当前最合理的治疗是【A】继续化疗【B】左肝切除【C】观察【D】介入治疗【答案】B【答案解析】该患者为直肠癌肝转移,继发性肝肿瘤局限于肝左叶内且结节≤3个,大小为2-3cm,最有效的治疗办法即为肝切除(B对),当肝转移肿瘤大小为5-10cm或≥10cm时,一般采用介入治疗。103、男性,50岁,因车轮碾压致左前臂外伤5小时。查体:神志清楚,左前臂明显肿胀疼痛,皮肤瘀斑,出血,成角畸形。应首先考虑的诊断为【A】桡骨头脱位【B】尺骨骨折【C】桡骨骨折【D】尺、桡骨骨折【答案】D【答案解析】男性,50岁,因车轮碾压(外伤史)致左前臂外伤5小时。查体:神志清楚,左前臂明显肿胀疼痛,皮肤瘀斑,出血,成角畸形(尺、桡骨骨折临床表现),根据患者的外伤史、临床表现首先考虑的诊断为尺、桡骨骨折(D对),桡骨头脱位(A错)多发生在五岁以下儿童,临床表现为病儿感肘部疼痛、活动受限,前臂处于半屈位或旋前位。尺骨骨折(B错)、桡骨骨折(C错)骨间膜的纤维方向呈由尺侧下方斜向桡侧上方,当单一尺骨或骨骨折时,暴力可由骨间膜传导到另一骨干,引起不同平面的双骨折,或发生一侧骨干骨折,另一骨的上端或下端脱位,尺桡骨干有多个肌肉附着,起、止部位分布分散。104、男性,50岁,车轮碾压致左前臂损伤,查体:左前臂肿胀疼痛,瘀斑,出血,成角移位。该患者治疗方案选择手法复位外固定的损伤是【A】损伤时间较短的外骨折【B】稳定骨折【C】血管神经损失【D】伴肌腱损伤【答案】B【答案解析】男性,50岁,因车轮碾压(外伤史)致左前臂外伤5小时。查体:神志清楚,左前臂明显肿胀疼痛,皮肤瘀斑,出血,成角畸形(尺、桡骨骨折临床表现),根据患者的外伤史、临床表现首先考虑的诊断为尺、桡骨骨折,该患者治疗方案选择手法复位外固定的损伤是稳定的骨折(B对),损伤时间较短的外骨折(A错)、血管神经损失少(C错)、不伴肌腱损伤(D错)为肱骨髁上骨折可选择手法复位外固定的损伤。105、如果患者突然出现疼痛加重,皮肤苍白,手指麻木,原因是什么【A】神经损伤【B】骨筋膜室综合征【C】急性骨髓炎【D】缺血性骨坏死【答案】B【答案解析】男性,50岁,因车轮碾压(外伤史)致左前臂外伤5小时。查体:神志清楚,左前臂明显肿胀疼痛,皮肤瘀斑,出血,成角畸形(尺、桡骨骨折临床表现),根据患者的外伤史、临床表现首先考虑的诊断为尺、桡骨骨折,如果患者突然出现疼痛加重,皮肤苍白,手指麻木,原因是骨筋膜室综合征(B对),神经损伤(A错)在神经与骨紧密相邻的部位,如肱骨中、下 /3交界处骨折极易损伤紧贴肱骨行走的桡神经。急性骨髓炎(C错)见于污染较重或伴有较严重的软组织损伤者,若清创不彻底、坏死组织残留或软组织覆盖不佳,导致骨外露,可能发生感染.处理不当。缺血性骨坏死(D错)常见的有腕舟状骨骨折后近侧骨折端缺血性坏死,股骨颈骨折后股骨头缺血性坏106、男性,14岁,无意中发现右膝内下圆形肿物,质硬,固定,局部无红肿热痛,X线显示右胫上端有一骨性突起,皮质和松质骨以宽广的蒂与正常骨相连。最可能的诊断是【A】骨样骨瘤【B】骨肉瘤【C】骨软骨瘤【D】骨巨细胞瘤【答案】C【答案解析】骨样骨瘤(A错)以疼痛为主,进行性加重,该患者肿块是无意中发现的,并且没有红肿热痛,不能诊断为骨样骨瘤,骨肉瘤(B错)以局部持续性疼痛为主,可伴有全身恶病质表现,该患者没有局部红肿热痛,不能诊断为骨肉瘤,胡软骨瘤(C对)长期无症状,多于无意中发现,X线在干骺端可见从皮质突向软组织的骨性突起,其皮质和松质骨以窄小或宽广的蒂与正常骨相连,该患者肿块于无意中发现,没有局部红肿热痛,X线显示右胫上端有一骨性突起,皮质和松质骨以宽广的蒂与正常骨相连,可以诊断为骨软骨瘤,骨巨细胞瘤(D错)主要症状为疼痛和肿胀,该患者无局部红肿热痛,故不能诊断为骨巨细胞瘤。107、男,14岁,右膝内下一圆形肿物,质硬,表面无红肿发热,X线示右胫骨上端有一骨性突起,皮质和骨质以宽大的蒂与正常骨相连。请问该患者用什么方法治疗?【A】根治性骨段切除,假体植入【B】化疗加放疗【C】骨肿瘤切除【D】无需治疗,观察【答案】D【答案解析】该患者右膝内下一圆形肿物,质硬,表面无红肿发热,X线示右胫骨上端有一骨性突起,皮质和骨质以宽大的蒂与正常骨相连,临床诊断为骨软骨瘤,无需治疗,观察(D对)为骨软骨瘤的治疗措施,骨肿瘤切除(C错)用于肿瘤生长过快,有疼痛或影响关节活动功能,该患者无疼痛等症状,故不用行骨肿瘤切除。根治性骨段切除,假体植入(A错)和化疗加放疗(B错)均用于恶性骨肿瘤,骨软骨瘤为良性肿瘤,无需根治性骨段切除,假体植入和化疗加放疗。108、某青年患者在高铁上突发心脏病,一位医生听到广播后立刻赶到现场实施急救,并协助联系下一站医院做好接治准备。由于抢救及时,措施到位,挽回了患者年轻的生命。此事件集中体现的医学人道主义精神是【A】救死扶伤【B】互助关爱【C】见义勇为【D】严谨求实【答案】A【答案解析】救死扶伤(A对)是该医生抢救及时,挽救患者的生命的过程中所体现的医学人道主义精神,互助关爱(B错)和见义勇为(C错)是人类的美好道德,并非医学人道主义精神,严谨求实(D错)是医务人员在学分方面应该遵循的医德规范,和抢救患者并未有直接联系。109、医生诊治病人时,恰当的沟通语言是【A】医学上的东西跟你说多了你也不知道【B】回去请按要求服药,否则达不到治疗效果【C】多久能治好,我也不知道【D】你为什么不听医生的话,下次再这样就不要来找我了【答案】B【答案解析】通过良好的医患沟通,医师能够把治疗方案、可能的并发症、疾病的转归和风险等及时传达给患者及其家属,使患者能够掌握更多的疾病诊治信息,消除患者疑虑,保障患者权益。故医生诊治病人时,告诉病人回去请按要求服药,否则达不到治疗效果(B对),为通过良好的医患沟通,把医生的医嘱及可能的并发症、疾病的转归、可能的风险,告知患者。110、患者女,32岁,诊断为子宫肌瘤,行手术治疗,术中发现子宫一侧有一囊肿,可一并切除,下列行为正确的是【A】直接切除,术后告知【B】嘱助手告知患者家属【C】先缝合手术伤口,待取得家属同意后再行手术【D】立即与家属商议,取得同意后手术【答案】D【答案解析】由于患者行手术治疗,诊断为子宫肌瘤,手术应为全麻手术,术中发现子宫一侧有一囊肿,全麻的患者在手术过程中遇到的难题应及时与家属取得联系,以取得患者家属知情,避免引起医疗纠纷。故术中发现子宫一侧有一囊肿应立即与家属商议,取得同意后手术(D对)。111、2003年SARS流行期间,某医院急诊室收治一名SARS患者,其家属悉心照料,未采取保护措施,在积极救治患者的同时应对患者家属采取什么措施【A】报告疾控部门,对家属进行隔离【B】没有权利对家属进行隔离【C】未确诊家属,不进行隔离【D】嘱其家属自行回家隔离【答案】A【答案解析】由于SARS属于传染病,故对患SARS的病人、病原携带者应报告疾控部门,对家属进行隔离(A对),隔离期限根据医学检查结果确定;由于其家属悉心照料,未采取保护措施,故其家属为疑似病人,对疑似病人,确诊前在指定场所单独隔离治疗(BCD错);对医疗机构内的病人、病原携带者、疑似病人的密切接触者,在指定场所进行医学观察和采取其他必要的预防措施。医疗机构对本单位内被传染病病原体污染的场所、物品以及医疗废物,必须依照法律、法规的规定实施消毒和无害化处置。112、医疗中患者的信息属于保密范围,医生为患者保密是医生的业务,但不是绝对义务。下面选项医生的做法能得到伦理辩护的是【A】将肿瘤患者的病理诊断结果告诉前来咨询的单位领导【B】按照保险公司的要求医生提供患者的病历资料【C】将麻疹患者信息告诉有关部门【D】将梅毒患者的感染信息告诉前来探视的同事【答案】C【答案解析】隐私保护权是医患关系中患者享有的一项权利,医疗中患者的信息属于保密范围,医生为患者保密是医生的业务,但不是绝对义务。当患者的“隐私”涉及他人或社会的利益,对他人或社会具有一定的危害性,如甲类传染病等, 则医务人员有疫情报告的义务,应当如实上报 ,麻疹属于国家法定乙类传染病,应当发现及时上报有关部门(C对)。单位领导、保险公司和前来探视的同事都是非直接利益相关人员,医者应当做好保密工作(ABD错)。113、临床医疗情境下,知情同意最重要的伦理意义【A】充分尊重患者的自主性和医疗决策权,由患者本人做出有关其个人的医疗决策【B】对于医疗中可能发生的种种风险和不适进行充分描述,因此有重要的医疗防御意义【C】患者有义务询问对自己医疗干预的益处和风险,据此医生向患者提供相关信息【D】向患者提供帮其做出最佳决策的信息和医疗建议,获得患者许可并授权的医学治疗【答案】D【答案解析】临床医疗情境下,医学伦理学要求尊重患者,知情同意是尊重患者的一种体现。 充分尊重患者的自主性和医疗决策权,由患者本人做出有关其个人的医疗决策(A错)。完全知情是指患者获悉他作出承诺所必需的一切医学信息 ,即通过医方详实的说明和介绍 、对有关询问的必需回答和解释,患者全面了解诊治决策的利与弊,例如诊治的性质、作用、依据、损伤、风险、意外等(BC错)。患者知情同意的理想状态是患者或其家属的完全知情并有效同意,向患者提供帮其做出最佳决策的信息和医疗建议,获得患者许可并授权的医学治疗(D对)。114、《纽伦堡法典》是1946年审判纳粹战犯的纽伦堡军事法庭会议的一部分,涉及到人体实验的十个道德要求,其第一条是【A】试验应立足于充分的动物实验已经获得的结果【B】试验前获得受试者的自愿同意是绝对的【C】试验的危险性不得超过试验目的的人道主义重要性【D】事先确信会发生死亡或瘫痪的试验是一律不得进行【答案】D115、暂缺116、交感缩血管神经纤维支配密度最高的血管是【A】脑血管【B】皮肤血管【C】内脏血管【D】骨骼肌血管【答案】B【答案解析】交感缩血管神经纤维在不同组织器官血管中的分布密度不同,分布密度最大的是皮肤血管(B对),其次为骨骼肌血管(D错)和内脏血管(B错),最小的是冠状血管和脑血管(A错)。117、交感缩血管神经纤维支配密度最低的血管是【A】脑血管【B】皮肤血管【C】内脏血管【D】骨骼肌血管【答案】A【答案解析】交感缩血管神经纤维在不同组织器官血管中的分布密度不同,分布密度最大的是皮肤血管(B错),其次为骨骼肌血管(D错)和内脏血管(B错),最小的是冠状血管和脑血管(A对)。118、病人除了听不懂别人话外,其他语言认知功能正常,听力无障碍,皮层损伤部位可能是【A】Broca区【B】颞上回后部【C】Wernicke区【D】角回【答案】B【答案解析】病人除了听不懂别人话外,其他语言认知功能正常,听力无障碍,为感觉性失语症的表现,能听到发音,但是听不懂说话的含义,皮层损伤部位为颞上回后部(B对)。Broca区(A错)的损伤可致运动失语症, 患者能看懂文字,也能听懂别人的说话,但自己却不会讲话,失去词语的组织搭配能力,不能用词语进行口头表达,但与发音有关的肌肉并不麻痹。Wernicke区(C错)的损伤可引起流畅失语症, 患者说话正常,有时说话过度,但言不达意,言语中充满杂乱语和自创词,对别人的说话和文字的理解能力也有明显缺陷。角回(D错)损伤可产生失读症患者看不懂文字,但其视觉并无损害,其他语言功能活动均仍健全。119、病人除了不能说话外,其他语言认知功能正常,发音无障碍,皮层损伤部位可能是【A】Broca区【B】颞上回后部【C】Wernicke区【D】角回【答案】A【答案解析】病人除了不能说话外,其他语言认知功能正常,发音无障碍,为运动性失语症的表现,能看懂文字,也能听懂别人的说话,但自己却不会讲话,失去词语的组织搭配能力,不能用词语进行口头表达,但与发音有关的肌肉并不麻痹,皮层损伤部位为Broca区(A对)。颞上回后部(B错)的损伤可引起感觉失语症, 患者能讲话及书写,也能看懂文字,但听不懂别人的谈话,因此不能回答别入的问题。Wernicke区(C错)的损伤可引起流畅失语症, 患者说话正常,有时说话过度,但言不达意,言语中充满杂乱语和自创词,对别人的说话和文字的理解能力也有明显缺陷。角回(D错)损伤可产生失读症患者看不懂文字,但其视觉并无损害,其他语言功能活动均仍健全。【学科】卫生法学110、2003年SARS流行期间,某医院急诊室收治一名SARS患者,其家属悉心照料,未采取保护措施,在积极救治患者的同时应对患者家属采取什么措施【A】报告疾控部门,对家属进行隔离【B】没有权利对家属进行隔离【C】未确诊家属,不进行隔离【D】嘱其家属自行回家隔离【答案】A【答案解析】由于SARS属于传染病,故对患SARS的病人、病原携带者应报告疾控部门,对家属进行隔离(A对),隔离期限根据医学检查结果确定;由于其家属悉心照料,未采取保护措施,故其家属为疑似病人,对疑似病人,确诊前在指定场所单独隔离治疗(BCD错);对医疗机构内的病人、病原携带者、疑似病人的密切接触者,在指定场所进行医学观察和采取其他必要的预防措施。医疗机构对本单位内被传染病病原体污染的场所、物品以及医疗废物,必须依照法律、法规的规定实施消毒和无害化处置。120、参加嘌呤核苷酸从头合成的关键酶【A】酰胺转移酶【B】天冬氨酸氨基甲酰转移酶【C】次黄嘌呤-鸟嘌呤磷酸核糖转移酶【D】尿苷/胞苷激酶【答案】A121、参加嘧啶核苷酸从头合成的关键酶【A】酰胺转移酶【B】天冬氨酸氨基甲酰转移酶【C】次黄嘌呤-鸟嘌呤磷酸核糖转移酶【D】尿苷/胞苷激酶【答案】B122、转运肝内合成的胆固醇至全身组织的脂蛋白是【A】CM【B】VLDL【C】LDL【D】HDL【答案】C123、转运肝外组织的胆固醇至肝内的脂蛋白是【A】CM【B】VLDL【C】LDL【D】HDL【答案】A124、细菌性感染早期浸润的细胞主要是?【A】中性粒细胞【B】巨噬细胞【C】嗜酸性粒细胞【D】淋巴细胞【答案】A【答案解析】细菌性感染早期浸润的细胞主要是中性粒细胞(A对)。125、寄生虫感染早期浸润的细胞主要是【A】中性粒细胞【B】巨噬细胞【C】嗜酸性粒细胞【D】淋巴细胞【答案】C【答案解析】寄生虫感染早期浸润的细胞主要是嗜酸性粒细胞(C对)。126、在儿童淋巴细胞瘤中,常以白血病表现的是【A】前体B淋巴细胞肿瘤【B】前体T淋巴细胞肿瘤【C】成熟B淋巴细胞肿瘤【D】成熟T淋巴细胞肿瘤【答案】A【答案解析】在儿童淋巴细胞瘤中,常以白血病表现的是前体B淋巴细胞肿瘤(A对)。127、儿童淋巴细胞瘤中,主要以淋巴瘤表现的是【A】前体B淋巴细胞肿瘤【B】前体T淋巴细胞肿瘤【C】成熟B淋巴细胞肿瘤【D】成熟T淋巴细胞肿瘤【答案】C128、男性,52岁10天前发热,咽痛,1天来突感心前区锐痛呈持续性,向左肩放射活动时加重,有高血压病年。查体:T37.5C P88次/分BP160/90mmHg 双肺(-),胸骨左缘3.4肋间可闻抓刮样音,收缩期明显,双本脉搏对称,该患者最可能的诊断是【A】急性心包炎【B】急性心肌炎【C】急性感染性心内膜炎【D】心脏压塞【答案】C【答案解析】患者十天前发热,查体为37.5℃,1天来突感心前区锐痛呈持续性,向左肩放射活动时加重,而发热是感染性心内膜炎(C对)最常见症状,除有些老年或心、肾衰竭重症病人外,几乎均有发热,有张弛热,一般小于39℃,常见头痛、背痛和肌肉关节痛;查体可闻及刮样音,高达85%的病人可闻及心脏杂音,可由基础心脏病和心内膜炎导致瓣膜损害所致,急性患者要比亚急性患者更易出现杂音强度和性质的变化,或出现新的杂音。129、女性46岁,10天前有发热,恶心,腹泻,2天来心悸伴心前区闷痛,活动后明显加重,夜间睡眠中有憋气感,既往体健,查体:T37.6C,P110次/分BP110/65mmHg,双肺底偶闻及湿啰音,心率整,心尖部可闻及S3奔马律,肝未及,该患者最可能的诊断是【A】急性心包炎【B】急性心肌炎【C】急性感染性心内膜炎【D】心脏压塞【答案】B【答案解析】患者10天前有发热,恶心,腹泻,2天来心悸伴心前区闷痛,活动后明显加重,夜间睡眠中有憋气感,既往体健,心肌炎(B对)多数病人发病前1-3周有病毒感染前驱症状,如发热、全身倦息感和肌肉酸痛或恶心、呕吐等消化道症状。随后可以有心悸、胸痛、呼吸困难、水肿,甚至晕厥、猝死。临床诊断的病毒性心肌炎绝大部分是以心律失常为主诉或首见症状。查体:T37.6C,P110次/分BP110/65mmHg,双肺底偶闻及湿啰音,心率整,心尖部可闻及S3奔马律,肝未及,查体常有心律失常,以房性与室性期前收缩及房室传导阻滞最为多见。心率可增快且与体温不相称。听诊可闻及第三第四心音或奔马律,部分病人可于心尖部闻及收缩期吹风样染音。心衰病人可有颈静脉怒张肺部湿哆音、肝大等体征。130、亚硝酸盐中毒的症状【A】皮肤粘膜灼伤【B】皮肤粘膜黄染【C】皮肤粘膜发绀【D】皮肤粘膜苍白【答案】C【答案解析】亚硝酸盐中毒的症状是全身皮肤黏膜发绀(C对)。131、毒蕈中毒的症状【A】皮肤粘膜灼伤【B】皮肤粘膜黄染【C】皮肤粘膜发绀【D】皮肤粘膜苍白【答案】B【答案解析】毒蕈中毒的症状为皮肤粘膜黄染(B对)。132、53岁男性,乙肝病史13年,中至重度食管胃底静脉曲张,HB110g/h,wbc2.3*10 plt32,肝功能分级child-pughA级,无出血史,赢选择的治疗方法【A】分流术【B】断流术【C】保守治疗【D】TIPS【答案】C133、48岁男性,乙肝病史8年,重度食管胃底静脉曲张,hb80,wbc3.1,plt36,child-pughC级,等待肝移植,近一年3次呕血,一天前出血1500ml,行三腔两管压迫,一天前拔出,仍有出血,进一步治疗应选择【A】分流术【B】断流术【C】保守治疗【D】TIPS【答案】D134、一侧上睑下垂,瞳孔缩小,眼球内陷的表现是【A】horner综合征【B】mirizzi综合征【C】budd chiari综合征【D】peutz jeghers综合征【答案】A135、胆囊结石压迫胆总管并致其狭窄表现是【A】horner 综合征【B】mirizzi综合征【C】budd chiari综合征【D】peutz jeghers综合征【答案】B136、通过激活酪氨酸激酶受体完成信号转导的配体有【A】胰岛素【B】肾上腺素【C】乙酰胆碱【D】神经生长因子【答案】AD【答案解析】酪氨酸激酶受体的胞内结构域具有酪氨酸激酶活性,胞外结构域则含有可结合配体的部位,各种生长因子如胰岛素(A对)和神经生长因子(D对)可通过激活酪氨酸激酶受体完成信号转导。肾上腺素(B错)和乙酰胆碱(C错)为G蛋白耦联受体的配体。137、下列关于NO对循环系统作用描述,正确的有【A】抑制血管平滑肌细胞增殖【B】使血管平滑肌细胞膜电位超极化【C】抑制血小板黏附,防止血栓形成【D】减少血管平滑肌细胞胞质内游离钙离Ca 2+离子浓度【答案】ACD【答案解析】NO可由血管内皮细胞生成和释放,通过扩散至血管平滑肌细胞并激活胞内可溶性鸟苷酸环化酶,使胞内cGMP水平增高,降低胞质内游离Ca2+浓度(D对)。NO还可通过抑制平滑肌细胞的增殖来维持血管的正常结构与功能(A对),另外,另外,NO可抑制血小板黏附,有助于防止血栓形成(C对)。内皮细胞产生的内皮超极化因子(EDHF)可通过促进Ca2+依赖的钾通道开放,引起血管平滑肌超极化,从而使血管舒张,而NO没有这一作用。138、气胸对机体造成的影响有【A】引起肺气肿【B】吸气阻力增加【C】呼气阻力增加【D】阻碍胸腔静脉血液,淋巴回流【答案】BD【答案解析】气胸为空气进入胸膜腔造成积气状态,当发生气胸时吸气,胸膜腔负压减小或消失,失去对肺的牵引作用,甚至因正压对肺产生压迫,使肺失去膨胀能力,胸扩张受限,故吸气阻力增加(B对C错)。气胸时由于胸膜腔负压减小或消失甚至胸膜腔正压的压迫,胸腔静脉和淋巴管可回流受阻(D对)。肺气肿是由于肺弹性成分大量破坏,肺回缩力减小造成的呼气功能障碍,气胸为肺弹性回缩力增大的吸气功能障碍,不会引起肺气肿(A错)。139、人在进食后可以促进胃排空的因素有【A】促胃液素【B】肠-胃反射【C】迷走-迷走反射【D】壁内神经丛反射【答案】CD【答案解析】食物由胃排入十二指肠的过程称为胃排空。食物对胃的扩张刺激可通过迷走-迷走反射(C对)和胃壁内神经丛反射(D对)引起胃运动的加强,促进胃排空。此外,食物对胃的扩张刺激和食物中某些化学成分可引起胃幽门部G细胞释放促胃液素,促胃液素能促进胃的运动,也能增强幽门括约肌的收缩,其总效应是延缓胃排空(A错)。而当食糜进入十二指肠后,食糜中的酸、脂肪和高渗性以及对肠壁的机械扩张均可刺激十二指肠内感受器,通过肠-胃反射抑制胃的运动,使胃排空减慢(B错)。140、关于肾脏NH3和NH4+排泄正确的有【A】近端小管主要分泌NH4+【B】集合管主要分泌NH3【C】与泌H+有关【D】与重吸收HCO3-有关【答案】CD【答案解析】近端小管、髓拌升支粗段和远端小管上皮细胞内的谷氨酰胺在谷氨酰胺酶的作用下脱氨,生成谷氨酸根和NH4+,可见NH4+不仅仅在近端小管分泌(A错),在集合管,氨的分泌机制有所不同。集合管上皮细胞膜对NH3高度通透,而对NH4+的通透性则较低,故细胞内生成的NH3以扩散方式进入小管液,与小管液中的打结合形成NH4+,并随尿排出体外,可见分泌NH3的部位不止集合管(B错)。NH3的分泌与甘的分泌密切相关。如果集合管分泌H+被抑制,则尿中排出的NH4+也减少。在生理情况下,肾脏分泌的H+有 50% 由NH3缓冲(C对),尿中每排出1个NH4+可有1个HCO3-被重吸收(D对)。141、在下列情况中,可使骨骼肌肌梭Ia类纤维传入冲动增加的有【A】骨骼肌肌梭收缩缩短时【B】骨骼肌肌梭被动拉长时【C】支配骨骼肌肌梭的α运动神经元兴奋时【D】支配骨骼肌肌梭的γ运动神经元兴奋时【答案】BD【答案解析】肌梭的传入纤维有Ia和II类纤维两类,Ia类纤维的末梢呈螺旋 形缠绕千核袋纤维和核链纤维的感受装置部位,当肌肉受外力牵拉而使肌梭感受装置被拉长时,螺旋形末梢发生变形而引起Ia类纤维传入冲动增加(B对A错)。当γ传出纤维受刺激,使肌梭两端的收缩成分收缩时,其收缩强度虽不足以引起整块肌肉缩短,但可牵拉肌梭感受装置,引起Ia类传入纤维放电增加(D对C错)。142、真核生物染色体DNA复制特征有【A】半保留复制【B】半不连续复制【C】双向复制【D】D-环复制【答案】ABC【答案解析】DNA复制的主要特征包括:半保留复制(A对)、双向复(C对)制和半不连续复制(B对),D-环复制(D错)是线粒体DNA复制特点。143、真核生物mRNA前体剪接部位的结构有【A】5’剪接位点为GU【B】3’剪接位点为AG【C】终止密码子的3’端【D】切割信号序列为5’-AAUAA-3’【答案】AB【答案解析】大多数内含子都以GU为5’的起始(A对),而末端则为AG-OH-3’(B对),切割信号序列为5’-AAUAA-3’(D对)。144、常发生磷酸化的氨基酸残基是【A】丝氨酸【B】苏氨酸【C】酪氨酸【D】苯丙氨酸【答案】ABC145、转录因子的DNA结合结构【A】锌指结构【B】螺旋-环-螺旋【C】富含脯氨酸结构域【D】亮氨酸拉链【答案】ABD146、下列属于真核生物基因组结构中的中度重复序列的有【A】短散在核元件(SINEs)【B】长散在核元件(LINEs)【C】反向重复序列【D】卫星DNA【答案】AB147、下列胆汁酸中,属于初级胆汁酸的有【A】胆酸【B】牛磺胆酸【C】鹅脱氧胆酸【D】甘氨鹅脱氧苷酸【答案】ACD148、下列病变中,属于脂肪变性的有【A】心肌细胞间出现脂肪细胞【B】肾小管上皮细胞内有脂滴【C】心肌细胞中出现脂滴【D】肝细胞水肿,内含大量红染细颗粒状物质【答案】BC149、下列情况中,属于肿瘤增生特点的有【A】增生与机体不协调【B】增生多为多克隆性【C】增生具有相对自主性【D】增生具有无限增殖的潜能【答案】ACD150、在慢性支气管炎中常见的病变有【A】柱状上皮纤毛脱落【B】支气管上皮鳞状化生【C】支气管管壁软骨变性、萎缩【D】支气管腺体黏液腺化生【答案】ABCD【答案解析】慢性支气管炎是发生于支气管粘膜及其周围组织的慢性非特异性炎性疾病,早起病变多局限于较大的支气管,随病情进展逐渐累及较小的支气管及细支气管。主要病变表现为:呼吸道粘液-纤毛排送系统受损,纤毛柱状上皮变性、坏死脱落,再生的上皮杯状细胞增多,并发生鳞状上皮化生,黏膜下腺体增生肥大和浆液性上皮发生粘液腺化生,导致粘液分泌增多;管壁充血水肿,淋巴细胞、浆细胞浸润;管壁平滑肌断裂、萎缩(喘息型者:平滑肌增生、肥大),软骨可变性、萎缩或肥大。151、亚急性重型肝炎的病理特点有【A】肝细胞亚大块坏死【B】肝细胞再生结节【C】残存肝细胞出现明显异型【D】网状纤维支架坍陷【答案】ABD【答案解析】重型病毒性肝炎根据发病缓急及病变程度的不同,分为急性和亚急性重型两种。亚急性重型肝炎病程较长(数周至数月),多数有急性重型肝炎迁延而来。镜下特点为既有肝细胞的亚大块坏死,又有结节状肝细胞再生。坏死区网状纤维支架塌陷和胶原化(无细胞硬化),因而使残存的肝细胞再生时不能沿原有支架排列,呈结节状,残存肝细胞较少出现异型性,肝细胞出现明显异型性多见于分化程度较低的肝细胞癌。152、下列病变中,属于胃癌晚期的是【A】癌细胞浸润至黏膜下层【B】癌细胞转移到局部淋巴结【C】癌细胞转移到双侧卵巢【D】癌细胞转移至左锁骨上淋巴结【答案】CD153、在肾炎肾穿刺活检切片中,发现颗粒型免疫荧光,该患者肾脏疾病的可能类型有【A】肺出血性肾炎综合征【B】链球菌感染后性肾炎【C】狼疮性肾炎【D】IgA肾病【答案】BCD154、胸水中葡萄糖含量降低可见于下列哪些疾病【A】脓胸【B】类风湿性关节炎【C】恶性胸水【D】系统性红斑狼疮【答案】ABCD【答案解析】正常胸腔积液中葡萄糖含量与血中含量相近。漏出液与大多数渗出液葡萄糖含量正常;而在脓胸(A对)、类风湿性关节炎(B对)中,其胸水葡萄糖含量明显降低;系统性红斑狼疮(D对)、恶性胸水(C对)和结核中含量可小于3.3mmol/L,明显降低。若胸膜病变范围较广,使葡萄糖及酸性代谢物难以透过胸膜,葡萄糖和pH均较低,提示肿瘤广泛浸润,其胸腔积液肿瘤细胞发现率高。155、男性,65岁,6年前曾患心肌梗死,现欲估患者心功能情况,可选用的检查有【A】动态心电图【B】超声心动图【C】放射性核素心肌显像【D】冠脉造影【答案】ABC【答案解析】正常或有功能的心肌细胞可选择性摄取某些显像药物,摄取量与该部位冠状动脉灌注血流量呈正比,也与局部心肌细胞的功能或活性密切相关。因此心脏核医学可以定量分析心肌灌注、心肌存活和心脏功能,其中显像技术包括心血池显像、放射性核素心肌显像(C对)等。动态心电图(A对)可以提供对非持续性心律失常及短暂心肌缺血发作的检出率。超声心动图(B对)如二维和M型超声心动图有助于了解心室壁的运动和左心室功能,及早发现并发症。冠脉造影(D错)是目前诊断冠心病的“金标准”,也是一项有创检查,不适合用于评估心脏功能。156、自身免疫性慢性萎缩性胃炎发生巨幼性红细胞贫血的主要机制是【A】内因子分泌减少【B】内因子抗体使其功能减退【C】胃吸收维生素B12减少【D】回肠吸收维生素B12减少【答案】ABD157、急性肾衰竭紧急透析指针【A】血钾7.0mmol/L【B】动脉血ph7.25【C】严重肾损伤性脑病【D】利尿剂无效的严重肺水肿【答案】ACD158、根据MDS的FAB分型标准,下列符合难治性贫血伴原始细胞增多转变型的有【A】外周血原始细胞大于等于50%【B】骨髓原始细胞>20%而<30%【C】幼粒细胞胞浆内出现Auer小体【D】环形铁粒幼>15%【答案】BC159、Cushing综合征可出现的临床表现有【A】贫血【B】皮肤色素沉着【C】病理性骨折【D】精神异常【答案】BCD160、目前肺癌最常见的病理类型有【A】大细胞肺癌【B】小细胞肺癌【C】鳞状细胞癌【D】腺癌【答案】BCD【答案解析】肺癌通常分为小细胞肺癌和非小细胞肺癌两大类。2015年世界卫生组织(WHO)修订的病理分型标准,较为常见的肺癌病理类型有以下几种:鳞状细胞癌(C对)、腺癌(D对)、小细胞肺癌(B对)。大细胞肺癌(A错)是少见的肺癌病理类型。161、失血时的输血原则,正确的是【A】失血量低于总血容量的10%,不需要输血【B】失血量占总血容量的10%-20%,输入晶体和胶体液【C】失血量占总血容量的20%-30%,输入适当浓缩红细胞【D】失血量大于总血容量的30%,应该全部输入全血【答案】ABC【答案解析】失血时的输血原则中,一次失血量低于总血容量10%时,不需要输血(A对),可通过机体自身代偿;当失血量占总血容量的10%-20%时,可输入适量晶体液、胶体液(B对)或少量血浆代用品;当失血量占总血容量的20%-30%时,可适当输入浓缩红细胞(C对);当失血量大于总血容量的30%时,可输全血与CRBC各半,因此不应该全部输入全血(D错)。162、长期肠外营养可能产生的并发症有【A】肝功能损害【B】肾功能损害【C】水、电解质平衡紊乱【D】骨质疏松【答案】ACD【答案解析】长期肠外营养可能产生的并发症有:代谢性并发症:高血糖、低血糖、氨基酸代谢紊乱高血脂、水、电解质失衡紊乱(C对);还可引起肝脏损害(A对),肠源性感染,但肾功能损害(B错)不是由于肠外营养导致;代谢性骨病:骨钙丢失、骨质疏松(D错)、血碱性磷酸酶增高、高钙血症、尿钙排出增加、四肢关节疼痛甚至出现骨折等。163、丹毒的临床特点有【A】B-溶血性链球菌是其主要病菌【B】口腔溃疡是其激发因素【C】反复发作可以发生组织坏死【D】治愈后易复发【答案】BD【答案解析】丹毒是乙型溶血性链球菌侵袭感染所致,B-溶血性链球菌不是其主要病菌(A错),大多常先有病变远端皮肤或黏膜的某种病损,如口腔溃疡(B对)等。反复发作常累及引流区淋巴结,但局部很少有组织坏死(C错)或化脓,全身炎症反应明显,治愈后易复发(D对)。164、造成半月板损伤的因素有【A】膝的半屈【B】膝的挤压【C】膝的内收外展【D】膝的旋转【答案】ABCD【答案解析】半月板是充填在股骨和胫骨关节间隙内的纤维软骨,每个膝关节有两个半月板,分别是内侧半月板和外侧半月板,周围厚,中间薄。主要作用是保持关节稳定性,承受重力、吸收震荡、润滑关节、协同膝关节的伸屈以及旋转。研磨力量是产生半月板破裂的主要原因。当膝关节处于半屈(A对)状态,股骨髁于半月板的接触面缩小,由于重力的影响,半月板的下面与胫骨平台接触固定,此时若膝关节猛烈的旋转(D对),可产生巨大的研磨力量造成半月板破裂。膝的长期负荷过重会产生对半月板的挤压(B对),进而对半月板产生研磨作用,导致半月板损伤。当膝关节做内收或外展(C对)时,两侧半月板位于一前一后,动作突然时,半月板来不及滑移,就会使半月板在股骨髁和胫骨平台之间发生研磨导致半月板破裂。165、关于粘连性肩关节囊炎,正确的【A】最主要的激发因素是肩部急性损伤【B】肩盂肱关节囊炎性粘连,僵硬,致关节疼痛和活动受限【C】颈椎病可诱发本病【D】本病有自限性【答案】BCD【答案解析】粘连性肩关节囊炎最主要的激发因素是长期过度活动,姿势不良等(A错),肩部急性损伤是其肩部原因,但不是主要激发因素。粘连性肩关节囊炎的特点为肩盂肱关节囊炎性粘连,僵硬,肩关节周围疼痛、各方向活动受限(B对)。颈椎病(C对)引起的肩部牵涉痛,因原发病长期不愈是肩部肌持续性痉挛、缺血而形成炎性病灶,转变为真正的粘连性肩关节囊炎。粘连性肩关节囊炎的临床特点为1.本病有自限性;2.本病多为中老年患者;3.肩各方向主动、被动活动均不同程度受限,以外旋外展和内旋后伸最重;4、影像学:X线平片见肩关节结构正常,可有不同程度骨质疏松,MRI见关节囊增厚,肩部滑囊可有渗出。