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临床医学专业：《内科学》_内分泌和代谢系统

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C.甲状腺激素 D性腺激素 E生长激素 2218在以下抗利尿激素不适当分泌综合征的病因中哪项最常见?(中,理解) A.小细胞型肺癌 B.淋巴肉瘤 C.胰腺癌 D.胸腺癌 E.前列腺癌 2219.男性,18岁。身高135m,因身体矮小来诊。体检:形体均匀,智力基本正常。骨龄延迟,相当10岁。生长激素水平明显增高,诊断为侏儒症,以下哪项治疗是正确的? (中,理解 A.胰岛素皮下注射 B.口服1,25(OH2维生素D3 C.生长激素替代治疗 D.生长激素+雄激素替代治疗 E. IGF-1 2220.患者因库欣病行垂体腺瘤切除术后1年,定期随访疾病是否复发需要定期随访疗效的指标是:(中,理解) A.13吸收率 B.T3、T4水平 C.尿17羟、17酮水平 D.全天血糖监测 E.血浆皮质醇节律 2221. A 45 years old woman consults with you because of the development of increasing hyperpigmentation and headache, and her state deiver's licensing bureau refusing to renew her driver's license because of a loss of her peripheral vision on a screening exam. Important is the fact that the patient had Cushing disease, with bilateral adrenalectomy done 3 years ago. She is on glucocorticoid and mineralcoricoid replacement. The patient most likely has(易、应用) A. addoson's diease B. recurrent Cushings syndrome C. Schmidt's syndrome D. Nelson syndrome E. None of the above 222 The most common tumors affecting the hypothalamus are(易、应用) B. Suprasellar dysgerminomas C. Pituitar adenomas D. Hypothalamic hamartomas E. None of the above *2223. A 36-year-old white woman presents to you for evaluation of a 6-month history of polyuria, voiding 8 to 10 liters of urine mainly during the daytime hours. The patients states that she remains thirsty most of the time and drinks about 10 to 12 liters of different kinds of fluids every day. She has no family history of similar conditions. Her past medical history is significant fo depression, for which she takes amitryptiline. Her physical examination is unremarkable, A andom serum sodium level is 138 mEq per liter, potassium level is 3.9 mEq per liter calcium

C.甲状腺激素 D.性腺激素 E.生长激素 2218.在以下抗利尿激素不适当分泌综合征的病因中哪项最常见？（中，理解） A. 小细胞型肺癌 B. 淋巴肉瘤 C. 胰腺癌 D. 胸腺癌 E. 前列腺癌 2219. 男性，18 岁。身高 1.35m，因身体矮小来诊。体检：形体均匀，智力基本正常。骨龄延迟，相当 10 岁。生长激素水平明显增高，诊断为侏儒症，以下哪项治疗是正确的？（中，理解） A. 胰岛素皮下注射 B．口服 1,25(OH)2 维生素 D 3 C．生长激素替代治疗 D．生长激素+雄激素替代治疗 E．IGF－1 2220.患者因库欣病行垂体腺瘤切除术后 1 年，定期随访疾病是否复发需要定期随访疗效的指标是：（中，理解） A．131I 吸收率 B．T3、T4 水平 C．尿 17 羟、17 酮水平 D．全天血糖监测 E. 血浆皮质醇节律 2221.A 45 years old woman consults with you because of the development of increasing hyperpigmentation and headache, and her state deiver’s licensing bureau refusing to renew her driver’s license because of a loss of her peripheral vision on a screening exam. Important is the fact that the patient had Cushing’ disease, with bilateral adrenalectomy done 3 years ago. She is on glucocorticoid and mineralcoricoid replacement. The patient most likely has（易、应用） A. addoson’s diease B. recurrent Cushing’s syndrome C. Schmidt’s syndrome D. Nelson syndrome E. None of the above 2222. The most common tumors affecting the hypothalamus are （易、应用） A. Craniopharyngiomas B. Suprasellar dysgerminomas C. Pituitar adenomas D. Hypothalamic hamartomas E. None of the above *2223. A 36-year-old white woman presents to you for evaluation of a 6-month history of polyuria, voiding 8 to 10 liters of urine mainly during the daytime hours. The patients states that she remains thirsty most of the time and drinks about 10 to 12 liters of different kinds of fluids every day. She has no family history of similar conditions. Her past medical history is significant for depression, for which she takes amitryptiline. Her physical examination is unremarkable, A random serum sodium level is 138 mEq per liter, potassium level is 3.9 mEq per liter calcium

level is 9.1 mEq per liter, and albumin level is 3.8 grams per deciliter. A urine specific gravity was 1.003. The patient underwent a dehydration test and, after approximately 20 hours of dehydration, her plasma osmolality was 298 and her urine osmolality stabilized at 806. She was given 5 units of aqueous vasopressin subcutaneously, and 1 hour later her urine osmolality was 810. The most appropriate next step is（难、应用） A. Initiate demeclocycline therapy B. Encourage the patient to decrease her fluid intake C. Initiate DDAVP therapy D. Initiate oral chlorpropamide theapy E. Initiate hydrochlorothiazide therapy 2224.单纯性甲状腺肿最常见的病因是：（中、记忆） A．缺碘 B．桥本甲状腺炎后 C．碘过多 D．药物性甲状腺功能减退 E．先天性缺陷 *2225.甲状腺激素的合成是由无机碘经过活化、与甲状腺球蛋白上的酪氨酸结合形成一碘酪氨酸（MIT）、二碘酪氨酸（DIT）、碘化的酪氨酸进一步偶联，最终形成甲状腺原氨酸（T3、 T4）并释放进入血循环。那么，在血液中，哪个激素全部来自甲状腺分泌的？（难、记忆） A．MIT B．DIT C．T3 D．T4 E．rT3 *2226. Graves’病是一种自身免疫性甲状腺疾病，血清中存在自身抗体， TSAb 免疫学来源之一的抗独特型抗体，是指针对哪个自身抗原的抗体？（难、理解） A．促甲状腺激素受体（TSHR） B．甲状腺球蛋白（TG） C．促甲状腺激素（TSH） D．甲状腺过氧化物酶（TPO） E．甲状腺微粒体 2227.发生甲状腺机能亢进时，可检测出血循环甲状腺激素水平升高，下列哪项检查能反映下丘脑－垂体－甲状腺轴功能？（中、理解） A．TT3、TT4 B．TT4、FT4 C．TT3、FT3 D．TSH E．FT3、FT4 2228.甲状腺亢进症浸润性突眼的原因主要是（中、理解） A．上眼肌的痉挛回缩 B．交感神经兴奋 C．眼球后组织的浸润水肿 D．眼球后新生物 E．眼球肿胀 2229.Graves 病的临床症状的严重程度与下列哪项因素有关？（中、记忆） A.突眼度

B代谢率升高的程度 C.甲状腺肿大的程度 D体重下降的程度 E.131吸收率 2230. A 40 years old woman comes to you because of generalized weakness, dizziness, and cold intolerance. A physical examination is positive for a mildly enlarged, firm, rubbery textured goiter. Her thyroid test reveals a free thyroxine level of 0. 5ug per deciliter(normal 0.7-1. 85)with TSH level of 28mlU/ml (normal: 0.3-5 ). The patient is begun on levothyroxine at 100ug per da Approximately I month later, she presents back to you with a 10 day history of generalized weakness, nausea, and vomiting and is noted to be hypotensive in the office. All the following are likely to be present in this patient EXCEPT:(易、应用) A. positive antimicrosomal antibody titers B C. A M. cortisol level of 3ug per deciliter D. History of transient hyperthyroidism a few months ago E. Normal FT4 level after I month on levothyroxine therapy 2231.A 32-year-old man is referred to you for evaluation of thyrotoxicosis. A referring physician noted, as you do from the history, that the patient has had increasing heat intolerance over the past 3 to 4 months, with a 10-to 15-ob weight loss, insomnia, tremor, and palpitations. The initial lab word done by the referring physician and sent to you revealed a Ft4 level of 0.6 ug per deciliter(normal: 0.5 to 1.85)and TSH level of less than 0.05 mlU per milliliter( normal: 0.32 to 5.0). A thyroid scan with uptake reveals essentially no visualization of the thyroid, and the 24-hour uptake was 1.5%. The patient denies any tenderness of the neck or any other symptoms except those noted. On examination, the patient has a normal blood pressure with a pulse of 110 beats per minute;warm,clammy skin; a fine tremor of his hands; velvety smooth skin; and small thyroid He has no history of thyroid surgery. His repeated FT4 and TSH tests confirm the findings by the The next step to take in the evaluation of this patient would be(易、应用) A. Repeat his thyroid scan and uptake B. Measure TSH receptor antibodies C. Do a thyrotropin-releasing hormone stimulation test D. Measure total serum T3 level E. place the patient on levothyroxine therapy and return him to his primary care physician 2232. Features associated with Graves's disease include which of the following?(易、应用) A Infiltrative ophthalmopathy B. Pretibial myxede C. Thtroid acropachy D Diffuse lymphadenopathy with splenomegaly E. All of above *2233. A 25-year-old woman in her eighth week of pregnancy is referred to you with an actual 3-lb weight loss during her pregnancy, palpitations, decreased appetite, tremor, and insomnia. Her obstetrician noted that her thyroid was enlarged to three times normal in a diffuse manner, and her thyroid test revealed a FT4 level of 3. 4 u g per deciliter(normal: 0.5 to 1.8)and TSH level fo less than 0.05 mlU per milliliter(normal: 0.5 to 5.0). The patient has had no nausea or vomiting Your physical examination reveals a diffusely enlarged, nontender thyroid, and she is noted to have bilateral proptosis, with a measurement by a Hertel exophthalmometer of 23mm(normal

B.代谢率升高的程度 C.甲状腺肿大的程度 D.体重下降的程度 E.131I 吸收率 2230.A 40 years old woman comes to you because of generalized weakness, dizziness, and cold intolerance. A physical examination is positive for a mildly enlarged, firm, rubbery textured goiter. Her thyroid test reveals a free thyroxine level of 0.5ug per deciliter (normal 0.7-1.85)with TSH level of 28mIU/ml (normal: 0.3-5). The patient is begun on levothyroxine at 100ug per day. Approximately 1 month later, she presents back to you with a 10 day history of generalized weakness, nausea, and vomiting and is noted to be hypotensive in the office. All the following are likely to be present in this patient EXCEPT: （易、应用） A. positive antimicrosomal antibody titers B. eosinophilia C. A.M. cortisol level of 3ug per deciliter D. History of transient hyperthyroidism a few months ago E. Normal FT4 level after 1 month on levothyroxine therapy 2231.A 32-year-old man is referred to you for evaluation of thyrotoxicosis. A referring physician noted, as you do from the history, that the patient has had increasing heat intolerance over the past 3 to 4 months, with a 10- to 15-ob weight loss, insomnia, tremor, and palpitations. The initial lab word done by the referring physician and sent to you revealed a FT4 level of 0.6μg per deciliter(normal: 0.5 to 1.85) and TSH level of less than 0.05 mIU per milliliter(normal: 0.32 to 5.0). A thyroid scan with uptake reveals essentially no visualization of the thyroid, and the 24-hour uptake was 1.5%. The patient denies any tenderness of the neck or any other symptoms except those noted. On examination, the patient has a normal blood pressure with a pulse of 110 beats per minute; warm, clammy skin; a fine tremor of his hands; velvety smooth skin; and small thyroid. He has no history of thyroid surgery. His repeated FT4 and TSH tests confirm the findings by the referring physician. The next step to take in the evaluation of this patient would be（易、应用） A. Repeat his thyroid scan and uptake B. Measure TSH receptor antibodies C. Do a thyrotropin-releasing hormone stimulation test D. Measure total serum T3 level E. place the patient on levothyroxine therapy and return him to his primary care physician 2232. Features associated with Graves’s disease include which of the following? （易、应用） A. Infiltrative ophthalmopathy B. Pretibial myxedema C. Thtroid acropachy D. Diffuse lymphadenopathy with splenomegaly E. All of above *2233. A 25-year-old woman in her eighth week of pregnancy is referred to you with an actual 3-lb weight loss during her pregnancy, palpitations, decreased appetite, tremor, and insomnia. Her obstetrician noted that her thyroid was enlarged to three times normal in a diffuse manner, and her thyroid test revealed a FT4 level of 3.4μg per deciliter(normal: 0.5 to 1.8) and TSH level fo less than 0.05 mIU per milliliter (normal: 0.5 to 5.0). The patient has had no nausea or vomiting. Your physical examination reveals a diffusely enlarged, nontender thyroid, and she is noted to have bilateral proptosis, with a measurement by a Hertel exdophthalmometer of 23mm (normal:

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临床医学专业：《内科学》_内分泌和代谢系统