内科学 模拟试题 之六 内分泌代谢系统Word格式.docx

1、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 221

2、6.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 ,ACTHC.PRL, LH/FSH, TSH, ACTHD.ACTH, LH/FSH, PRL, TSHE.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.ACTHB.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，

3、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D 3C生长激素替代治疗D生长激素+雄激素替代治疗EIGF1 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：A131I吸收率BT3、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 incr

4、easing hyperpigmentation and headache, and her state deivers licensing bureau refusing to renew her drivers 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 glu

5、cocorticoid and mineralcoricoid replacement. The patient most likely has（易、应用）A. addosons dieaseB. recurrent Cushings syndromeC. Schmidts syndromeD. Nelson syndromeE. None of the above2222. The most common tumors affecting the hypothalamus are （易、应用）A. CraniopharyngiomasB. Suprasellar dysgerminomasC

6、. Pituitar adenomasD. Hypothalamic hamartomas*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 lite

7、rs 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 mE

8、q 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 w

9、as 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 therapyB. Encourage the patient to decrease her fluid intakeC. Initiate DDAVP therapyD. Initiate oral chlorpropamide theapyE. Initi

10、ate hydrochlorothiazide therapy2224.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）AMITBDITCT3DT4ErT3*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

11、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）ATT3、TT4BTT4、FT4CTT3、FT3DTSHEFT3、FT42228.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

12、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

13、.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

14、 to be present in this patient EXCEPT: （易、应用）A. positive antimicrosomal antibody titersB. eosinophiliaC. A.M. cortisol level of 3ug per deciliterD. History of transient hyperthyroidism a few months agoE. Normal FT4 level after 1 month on levothyroxine therapy2231.A 32-year-old man is referred to you

15、 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

16、sent to you revealed a FT4 level of 0.6g 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 t

17、he 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

18、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 uptakeB. Measure TSH receptor antibodiesC. Do a thyrotropin-releasing hormone stimulation testD. Measure total serum T3 levelE. place the patient on le

19、vothyroxine therapy and return him to his primary care physician2232. Features associated with Gravess disease include which of the following?A. Infiltrative ophthalmopathyB. Pretibial myxedemaC. Thtroid acropachyD. Diffuse lymphadenopathy with splenomegalyE. All of above*2233. A 25-year-old woman i

20、n 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

21、 3.4g 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

22、 Hertel exdophthalmometer of 23mm （normal: 20）. Based on the findings and her laboratory data, you would recommend as the best therapy for her（难、应用）A. Initiation of propylthiouracilB. Initiation of methimazoleC. Treatment only with propranolol, planning treatment throughout pregnancyD. Plan a referr

23、al to a surgeon during the second trimester of pregnancy for a subtotal thyroidectomyE. Recommend no treatment and simply follow thyroid function tests, because her hyperthyriod state is due to elevated human chorionic gonadotropin2234.鉴别原发性与继发性甲状腺功能减退最佳方法是（易、理解）ATT3、TT4测定B甲状腺131I摄取率CFT3、FT4 DTSH测定E

24、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 DTSH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. Which of the following may require a higher dosage of levothyroxine to be given

25、to a hypothyroid patient? （中、应用）A. CholestyramineB. Ferrous suofateC. RifampinD. Third-trimester pregnancyE. All of the above*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

26、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） ATGA、TPO升高 BTRAb升高Dh-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3cm5cm，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） AT3、T4B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

27、（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. A 45-year-old woman is referred to you after a thyroid nodule was found on routine physical exam. The patient was not aware that she had a mass in her thyroid and has no history of any previous thyroid disease or thyroid nodule. There is no family hi

28、story of thyroid disease or thyroid nodules. The patient has no history of radiation therapy of any type to the head or neck. The patient has no symptoms of hyper- or hypothyroidism. Lab tests reveal a TSH level of 1.5 mIU per milliliter（normal: 0.32 to 5）, and the patient undergoes a fine-needle as

29、piration biopsy of this nodule. The pathology report reveals a hyper cellular lesion with no colloid, consistent with a follicular lesion. Your next step in the evaluation of this patients thyroid nodule, based on the laboratory and cytopathologic findings noted above, is （难、应用）A. Refer the patient to a surgeon specializing in thyroid surgery for thyroidectomyB. Initiate levothyroxine therapy to suppress the nodule C. Recommend follow-up with ultrasound in 6 months to see if the nodule is increasing in sizeD. Do a thyroid scan to determine if the nodule is hot versus cold