内科学 模拟试题 之六 内分泌代谢系统Word格式.docx
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D.面肌扣击试验
E.皮肤划痕试验
2214.45岁男性患者,因自己发现双侧乳房增大就诊。
医生询问病史发现其性欲降低约3年余,近2年出现性功能下降、阳痿。
为了明确诊断,该医师给病人做了有关检查,但该医师少做了一项检查,而使疾病未得到明确诊断,你认为该医师未做的检查最有可能是下列哪一项?
A.血浆ACTH水平
B.血浆PRL水平
C.血浆胰岛素水平
D.血浆PTH水平
E.血浆肾素-血管紧张素-醛固酮水平测定
2215.对垂体泌乳素瘤的治疗大多采用药物药物-----溴隐停属于哪一类?
A.多巴胺受体激动剂
B.多巴胺受体拮抗剂
C.5-羟色胺再摄取抑制剂
D.5-羟色胺能受体拮抗剂
E.H2-受体拮抗剂
2216.腺垂体功能减退时,垂体激素分泌受累的次序不同,以下顺序中哪一种是正确的?
A.TSH,FSH/LH,PRL,ACTH,
B.LH/FSH,PRL,TSH,ACTH
C.PRL,LH/FSH,TSH,ACTH
D.ACTH,LH/FSH,PRL,TSH
E.TSH,ACTH,LH/FSH,PRL
2217.治疗腺垂体功能减退时,应首先补充下列哪项激素最为重要?
A.ACTH
B.糖皮质激素
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?
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?
A.胰岛素皮下注射
B.口服1,25(OH)2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:
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.A45yearsoldwomanconsultswithyoubecauseofthedevelopmentofincreasinghyperpigmentationandheadache,andherstatedeiver’slicensingbureaurefusingtorenewherdriver’slicensebecauseofalossofherperipheralvisiononascreeningexam.ImportantisthefactthatthepatienthadCushing’disease,withbilateraladrenalectomydone3yearsago.Sheisonglucocorticoidandmineralcoricoidreplacement.Thepatientmostlikelyhas(易、应用)
A.addoson’sdiease
B.recurrentCushing’ssyndrome
C.Schmidt’ssyndrome
D.Nelsonsyndrome
E.Noneoftheabove
2222.Themostcommontumorsaffectingthehypothalamusare(易、应用)
A.Craniopharyngiomas
B.Suprasellardysgerminomas
C.Pituitaradenomas
D.Hypothalamichamartomas
*2223.A36-year-oldwhitewomanpresentstoyouforevaluationofa6-monthhistoryofpolyuria,voiding8to10litersofurinemainlyduringthedaytimehours.Thepatientsstatesthatsheremainsthirstymostofthetimeanddrinksabout10to12litersofdifferentkindsoffluidseveryday.Shehasnofamilyhistoryofsimilarconditions.Herpastmedicalhistoryissignificantfordepression,forwhichshetakesamitryptiline.Herphysicalexaminationisunremarkable,Arandomserumsodiumlevelis138mEqperliter,potassiumlevelis3.9mEqperlitercalciumlevelis9.1mEqperliter,andalbuminlevelis3.8gramsperdeciliter.Aurinespecificgravitywas1.003.Thepatientunderwentadehydrationtestand,afterapproximately20hoursofdehydration,herplasmaosmolalitywas298andherurineosmolalitystabilizedat806.Shewasgiven5unitsofaqueousvasopressinsubcutaneously,and1hourlaterherurineosmolalitywas810.Themostappropriatenextstepis(难、应用)
A.Initiatedemeclocyclinetherapy
B.Encouragethepatienttodecreaseherfluidintake
C.InitiateDDAVPtherapy
D.Initiateoralchlorpropamidetheapy
E.Initiatehydrochlorothiazidetherapy
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?
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.131I吸收率
2230.A40yearsoldwomancomestoyoubecauseofgeneralizedweakness,dizziness,andcoldintolerance.Aphysicalexaminationispositiveforamildlyenlarged,firm,rubberytexturedgoiter.Herthyroidtestrevealsafreethyroxinelevelof0.5ugperdeciliter(normal0.7-1.85)withTSHlevelof28mIU/ml(normal:
0.3-5).Thepatientisbegunonlevothyroxineat100ugperday.Approximately1monthlater,shepresentsbacktoyouwitha10dayhistoryofgeneralizedweakness,nausea,andvomitingandisnotedtobehypotensiveintheoffice.AllthefollowingarelikelytobepresentinthispatientEXCEPT:
(易、应用)
A.positiveantimicrosomalantibodytiters
B.eosinophilia
C.A.M.cortisollevelof3ugperdeciliter
D.Historyoftransienthyperthyroidismafewmonthsago
E.NormalFT4levelafter1monthonlevothyroxinetherapy
2231.A32-year-oldmanisreferredtoyouforevaluationofthyrotoxicosis.Areferringphysiciannoted,asyoudofromthehistory,thatthepatienthashadincreasingheatintoleranceoverthepast3to4months,witha10-to15-obweightloss,insomnia,tremor,andpalpitations.TheinitiallabworddonebythereferringphysicianandsenttoyourevealedaFT4levelof0.6μgperdeciliter(normal:
0.5to1.85)andTSHleveloflessthan0.05mIUpermilliliter(normal:
0.32to5.0).Athyroidscanwithuptakerevealsessentiallynovisualizationofthethyroid,andthe24-houruptakewas1.5%.Thepatientdeniesanytendernessoftheneckoranyothersymptomsexceptthosenoted.Onexamination,thepatienthasanormalbloodpressurewithapulseof110beatsperminute;
warm,clammyskin;
afinetremorofhishands;
velvetysmoothskin;
andsmallthyroid.Hehasnohistoryofthyroidsurgery.HisrepeatedFT4andTSHtestsconfirmthefindingsbythereferringphysician.
Thenextsteptotakeintheevaluationofthispatientwouldbe(易、应用)
A.Repeathisthyroidscananduptake
B.MeasureTSHreceptorantibodies
C.Doathyrotropin-releasinghormonestimulationtest
D.MeasuretotalserumT3level
E.placethepatientonlevothyroxinetherapyandreturnhimtohisprimarycarephysician
2232.FeaturesassociatedwithGraves’sdiseaseincludewhichofthefollowing?
A.Infiltrativeophthalmopathy
B.Pretibialmyxedema
C.Thtroidacropachy
D.Diffuselymphadenopathywithsplenomegaly
E.Allofabove
*2233.A25-year-oldwomaninhereighthweekofpregnancyisreferredtoyouwithanactual3-lbweightlossduringherpregnancy,palpitations,decreasedappetite,tremor,andinsomnia.Herobstetriciannotedthatherthyroidwasenlargedtothreetimesnormalinadiffusemanner,andherthyroidtestrevealedaFT4levelof3.4μgperdeciliter(normal:
0.5to1.8)andTSHlevelfolessthan0.05mIUpermilliliter(normal:
0.5to5.0).Thepatienthashadnonauseaorvomiting.Yourphysicalexaminationrevealsadiffuselyenlarged,nontenderthyroid,andsheisnotedtohavebilateralproptosis,withameasurementbyaHertelexdophthalmometerof23mm(normal:
<
20).Basedonthefindingsandherlaboratorydata,youwouldrecommendasthebesttherapyforher(难、应用)
A.Initiationofpropylthiouracil
B.Initiationofmethimazole
C.Treatmentonlywithpropranolol,planningtreatmentthroughoutpregnancy
D.Planareferraltoasurgeonduringthesecondtrimesterofpregnancyforasubtotalthyroidectomy
E.Recommendnotreatmentandsimplyfollowthyroidfunctiontests,becauseherhyperthyriodstateisduetoelevatedhumanchorionicgonadotropin
2234.鉴别原发性与继发性甲状腺功能减退最佳方法是(易、理解)
A.TT3、TT4测定
B.甲状腺131I摄取率
C.FT3、FT4
D.TSH测定
E.rT3测定
2235.下列与甲状腺功能减退有关的症状是(易、记忆)
A.重症肌无力
B.粘液性水肿面容
C.皮肤紫癜
D.甲状腺压痛
E.踝腱反射亢进
2236.TRH兴奋试验在原发性甲状腺功能减退患者中的结果是(中、理解)
A.呈正常反应
B.呈过度反应
C.呈近似正常反应
D.TSH几乎不受TRH兴奋
E.反应低下
2237.原发性甲状腺功能减退最常见的原因是(易、记忆)
A.慢性淋巴性甲状腺炎
B.亚急性甲状腺炎
C.甲状腺切除术后
D.甲状腺肿瘤
E.单纯性甲状腺
2238.Whichofthefollowingmayrequireahigherdosageoflevothyroxinetobegiventoahypothyroidpatient?
(中、应用)
A.Cholestyramine
B.Ferroussuofate
C.Rifampin
D.Third-trimesterpregnancy
E.Alloftheabove
*2239.亚急性甲状腺炎患者出现甲状腺功能亢进时,下列何种治疗最适当?
A.甲状腺次全切除
B.放射性核素治疗
C.心得安
D.碘剂治疗
E.他巴唑加心得安
2240.亚急性甲状腺炎,下列治疗方法哪项最有效?
(易、记忆)
A.消炎痛
B.强的松
E.甲状腺片
2241.慢性淋巴性甲状腺炎典型的体征是(易、记忆)
A.甲状腺结节扫描为冷结节
B.甲状腺结节扫描为温结节
C.甲状腺肿大伴触痛
D.甲状腺肿大、质硬、表面不光滑
E.结节性甲状腺肿
2242.诊断桥本甲状腺炎有价值的是(易、记忆)
A.TGA、TPO升高
B.TRAb升高
D.h-TG升高
2243.对诊断功能亢进性甲状腺腺瘤有意义的是(易、记忆)
B.甲状腺结节扫描为热结节
D.甲状腺肿大、质硬
2244.女性,49岁。
洗澡时无意中发现颈前部结节就诊。
甲状腺右叶可触及一结节3cm×
5cm,质韧,无压痛,血管杂音(-),对侧甲状腺未及肿大。
心率72次/min,律齐。
为进一步明确诊断,应首先选择哪项检查?
(中、应用)
A.T3、T4
B.甲状腺吸碘率测定
C.甲状腺扫描
D.基础代谢率测定
E.甲状腺球蛋白抗体(TGA)
2245.血清降钙素升高,是哪种疾病的较特异性标志(易,记忆)
A.甲状腺脓肿
B.甲状腺髓样癌
C.甲状腺囊肿
D.自主性高功能腺瘤
E.甲状腺滤泡癌
*2246.A45-year-oldwomanisreferredtoyouafterathyroidnodulewasfoundonroutinephysicalexam.Thepatientwasnotawarethatshehadamassinherthyroidandhasnohistoryofanypreviousthyroiddiseaseorthyroidnodule.Thereisnofamilyhistoryofthyroiddiseaseorthyroidnodules.Thepatienthasnohistoryofradiationtherapyofanytypetotheheadorneck.Thepatienthasnosymptomsofhyper-orhypothyroidism.LabtestsrevealaTSHlevelof1.5mIUpermilliliter(normal:
0.32to5),andthepatientundergoesafine-needleaspirationbiopsyofthisnodule.Thepathologyreportrevealsahypercellularlesionwithnocolloid,consistentwitha‘follicularlesion’.Yournextstepintheevaluationofthispatient’sthyroidnodule,basedonthelaboratoryandcytopathologicfindingsnotedabove,is(难、应用)
A.Referthepatienttoasurgeonspecializinginthyroidsurgeryforthyroidectomy
B.Initiatelevothyroxinetherapytosuppressthenodule
C.Recommendfollow-upwithultrasoundin6monthstoseeifthenoduleisincreasinginsize
D.Doathyroidscantodetermineifthenoduleis‘hot’versus‘cold’