临床医学专业：《内科学》_内分泌和代谢系统.doc_大学文库

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:

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 C.心得安 D.碘剂治疗 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 C.甲状腺肿大伴触痛 D.h-TG升高 E.结节性甲状腺肿 2243对诊断功能亢进性甲状腺腺瘤有意义的是(易、记忆) A.甲状腺结节扫描为冷结节 B.甲状腺结节扫描为热结节 C.甲状腺肿大伴触痛 D.甲状腺肿大、质硬 E.结节性甲状腺肿 224女性,49岁。洗澡时无意中发现颈前部结节就诊。体检:甲状腺右叶可触及一结节3cm ×5cm,质韧,无压痛,血管杂音(一),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. 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 history 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 mlU per milliliter( normal: 0.32 to 5), and the patient undergoes a fine-needle aspiration 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

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 C．心得安 D．碘剂治疗 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 C．甲状腺肿大伴触痛 D．h-TG 升高 E．结节性甲状腺肿 2243.对诊断功能亢进性甲状腺腺瘤有意义的是（易、记忆） A．甲状腺结节扫描为冷结节 B．甲状腺结节扫描为热结节 C．甲状腺肿大伴触痛 D．甲状腺肿大、质硬 E．结节性甲状腺肿 2244.女性，49 岁。洗澡时无意中发现颈前部结节就诊。体检：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. 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 history 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 aspiration 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 patient’s thyroid nodule, based on the

aboratory and cytopathologic findings noted above,is(难、应用) A. Refer the patient to a surgeon specializing in thyroid surgery for thyroidectomy B. Initiate levothyroxine therapy to suppress the nodule C. Recommend follow-up with ultrasound in 6 months to see if the nodule is increasing in size D. Do a thyroid scan to determine if the nodule ishot'versuscold' orwarm E. Advise the patient to have rebiopsy in 2 months 2247. Which of the following thyroid cancers are responsive to3 I therapy?(易、应用) A. Follicular cancer of the thyroid B. Medullary cancer of the thyroid C. Anaplastic thyroid D. Primary lymphoma of the thyroid E. Both a and c *2248. A 30-year-old man is evaluated for a thyroid nodule. The patient reports that his father died from thyroid cancer'and that a brother had a history of recurrent renal stones. Blood calcitonin concentration is 2000pg/mL(normal: less than 100); serum calcium and phosphate levels are normal Before referring the patient to a surgeon, the physician should(难、应用) A. obtain a liver scan B. perform a calcium infusion test C. measure urinary catecholamines D. administer suppressive doses of thyroxine and measure levels of thyroid stimulating hormone E. treat the patient with radioactive iodine 2249. An otherwise healthy 60-year-old man is noted on routine examination to have a firm thyroid nodule. Serum thyroxine is 8.0 W g/dL(normal: 4 to 11). Thyroid scan demonstrates cold'nodule. The appropriate management would be which of the following procedures? (53 应用 A. Complete lobectomy B. Fine needle aspiration cytology C. Levothyroxine D. Radioactive iodin therapy E. External irradiation 2250. A 60-year-old woman presents with generalized muscle weakness, loss If appetit palpitations, and a small diffuse nodular goiter. An electrocardiogram reveals rapid atrial fibrillation Despite adequate digitalization there is little slowing of her ventricular rate. Thyroid function studies reveal a serum thyroxine level of 12 u g/dl(normal: 5 to 12),with a triiodothyronine(T3)level of 200ng/dL(normal: 80 to 160), as measured by radioimmunoassay and a highly sensitive thyroid-stimulating hormone(TSH)of 0.05 H lU/mL(normal: 0.3 to 3.0) The most likely diagnosis and appropriate treatment would be(易、应用) A. typical Graves'disease; therapy with antithyroid drugs B. mild Graves'disease initiation of therapy with low dose of 3I C. tocic multinodular goiter; therapy with antithyroid drugs followed by surgery D. toxic multinodular goiter; therapy with antithyroid drugs followed by high dose of 3I when euthyroid E. sick euthyroid syndrome; continuation of treatment of heart disease with digoxin and propranolol 2251.ACIH依赖性皮质醇增多症最常见的病因是(易,记忆) A垂体ACTH细胞增生

laboratory and cytopathologic findings noted above, is （难、应用） A. Refer the patient to a surgeon specializing in thyroid surgery for thyroidectomy B. Initiate levothyroxine therapy to suppress the nodule C. Recommend follow-up with ultrasound in 6 months to see if the nodule is increasing in size D. Do a thyroid scan to determine if the nodule is ‘hot’ versus ‘cold’ or ‘warm’ E. Advise the patient to have rebiopsy in 2 months. 2247. Which of the following thyroid cancers are responsive to 131I therapy?（易、应用） A. Follicular cancer of the thyroid B. Medullary cancer of the thyroid C. Anaplastic thyroid cancer D. Primary lymphoma of the thyroid E. Both A and C *2248. A 30-year-old man is evaluated for a thyroid nodule. The patient reports that his father died from ‘thyroid cancer’ and that a brother had a historhy of recurrent renal stones. Blood calcitonin concentration is 2000pg/mL(normal: less than 100) ; serum calcium and phosphate levels are normal. Before referring the patient to a surgeon, the physician should （难、应用） A. obtain a liver scan B. perform a calcium infusion test C. measure urinary catecholamines D. administer suppressive doses of thyroxine and measure levels of thyroid stimulating hormone E. treat the patient with radioactive iodine 2249. An otherwise healthy 60-year-old man is noted on routine examination to have a firm thyroid nodule. Serum thyroxine is 8.0 μg/dL(normal: 4 to 11). Thyroid scan demonstrates a ‘cold ‘nodule. The appropriate management would be which of the following procedures? （易、应用） A. Complete lobectomy B. Fine needle aspiration cytology C. Levothyroxine D. Radioactive iodinw therapy E. External irradiation 2250. A 60-year-old woman presents with generalized muscle weakness, loss lf appetite, palpitations, and a small diffuse nodular goiter. An electrocardiogram reveals rapid atrial fibrillation. Despite adequate digitalization there is little slowing of her ventricular rate. Thyroid function studies reveal a serum thyroxine level of 12 μg/dL(normal: 5 to 12), with a triiodothyronine(T3) level of 200ng/dL(normal: 80 to 160), as measured by radioimmunoassay and a highly sensitive thyroid-stimulating hormone(TSH) of 0.05μIU/mL(normal: 0.3 to 3.0) The most likely diagnosis and appropriate treatment would be（易、应用） A. typical Graves’ disease; therapy with antithyroid drugs B. mild Graves’ disease; initiation of therapy with low dose of 131I C. tocic multinodular goiter; therapy with antithyroid drugs followed by surgery D. toxic multinodular goiter;therapy with antithyroid drugs followed by high dose of 131I when euthyroid E. sick euthyroid syndrome; continuation of treatment of heart disease with digoxin and propranolol 2251. ACTH 依赖性皮质醇增多症最常见的病因是（易，记忆） A 垂体 ACTH 细胞增生

E.螺内酯只能用于不能手术的原发性醛固酮增多症患者 2259原发性肾上腺皮质功能减退最主要的病因是(易,记忆) 特发性(包括自身免疫性和多发内分泌腺功能减退症) ABCD 肾上腺结核肾上腺转移癌脑垂体功能减退 E 先天性ACTH反应障碍 2260.下列哪一项检査对鉴别原发和继发性肾上腺皮质功能减退具有重要意义(中,理解) A血浆皮质醇节律 B24小时尿17一羟,17一酮测定 C24小时尿游离皮质醇测定 D基础ACIH测定 E肾上腺CT *2261先天性肾上腺皮质增生症( congenital adrenal hyperplasia,CAH)是由于肾上腺皮质激素生物合成酶系中某一或数种酶的先天性缺陷使皮质醇等激素水平改变所致的一组疾病。按缺陷酶的种类,可分五类,以下哪几种组合是正确的?(中,记忆) A.2l-羟化酶缺陷症,11-β-羟化酶缺陷症,3β-羟类固醇脱氢酶缺陷症,1α-羟化酶缺陷症, 胆固醇碳链酶缺陷症 B.21-羟化酶缺陷症失盐型,男性化型,不典型亚型,17α-羟化酶缺陷症,1l-β-羟化酶缺陷症, C.21-羟化酶缺陷症失盐型,男性化型,17α-羟化酶缺陷症l-β-羟化酶缺陷症,胆固醇碳链酶缺陷症 D.21-羟化酶缺陷症失盐型,单纯男性化型,非典型失盐型,皮质醇缺乏型,1-β-羟化酶缺陷症 E.2l-羟化酶缺陷症,1l-β-羟化酶缺陷症,3β-羟类固醇脱氢酶缺陷症,1邝β-羟化酶缺陷症,胆固醇碳链酶缺陷症 *2262.21-羟化酶缺陷症的典型特征是:(难、应用) A.有明显的男性化或女性假两性畸形、高钾血症、低钠血症,高睾酮血症,高血浆ACTH 低肾素活性,高17-羟孕酮 B.有明显的男性化或女性假两性畸形、高钾血症、低钠血症,高睾酮血症,高血浆ACTH 低血浆皮质醇,高17-a羟孕酮 C.有明显的男性化或女性假两性畸形、低钾血症、高钠血症,高睾酮血症,高血浆ACTH 高肾素活性,高17-羟孕酮 D.有明显的男性化或女性假两性畸形、高钾血症、低钠血症,低睾酮血症,高血浆ACTH 高肾素活性,高醛固酮血症。 E.有明显的男性化或女性假两性畸形、高钾血症、低钠血症,低睾酮血症,高血浆ACTH 高肾素活性,低醛固酮血症。 2263挑选出下列项目中符合嗜铬细胞瘤者:(中、理解) A.收缩压与舒张压均升高,高血压可呈间歇性或持续性发作 B.所谓 Sipple综合征是本症与慢性甲状腺炎的合并, C.尿中肾上腺素,去甲肾上腺素增多,但MA量不增多。 D.酚妥拉明( regitine)试验,可用于阵发性者,为激发试验 E.90%的嗜铬细胞瘤位于肾上腺皮质内。 *2264患者于切除嗜铬细胞瘤后即刻发生低血压,应立即采用下列哪种治疗?(难、应用) A.皮质类固醇 B.盐皮质激素

E．螺内酯只能用于不能手术的原发性醛固酮增多症患者 2259.原发性肾上腺皮质功能减退最主要的病因是（易，记忆） A 特发性（包括自身免疫性和多发内分泌腺功能减退症） B 肾上腺结核 C 肾上腺转移癌 D 脑垂体功能减退 E 先天性 ACTH 反应障碍 2260.下列哪一项检查对鉴别原发和继发性肾上腺皮质功能减退具有重要意义（中，理解） A 血浆皮质醇节律 B 24 小时尿 17－羟，17－酮测定 C 24 小时尿游离皮质醇测定 D 基础 ACTH 测定 E 肾上腺 CT *2261.先天性肾上腺皮质增生症(congenital adrenal hyperplasia, CAH)是由于肾上腺皮质激素生物合成酶系中某一或数种酶的先天性缺陷使皮质醇等激素水平改变所致的一组疾病。按缺陷酶的种类，可分五类,以下哪几种组合是正确的？（中，记忆） A. 21-羟化酶缺陷症, 11-β-羟化酶缺陷症, 3β-羟类固醇脱氢酶缺陷症, 17α-羟化酶缺陷症, 胆固醇碳链酶缺陷症 B. 21-羟化酶缺陷症失盐型, 男性化型, 不典型亚型, 17α-羟化酶缺陷症, 11-β-羟化酶缺陷症, C. 21-羟化酶缺陷症失盐型, 男性化型, 17α-羟化酶缺陷症, 11-β-羟化酶缺陷症, 胆固醇碳链酶缺陷症 D. 21-羟化酶缺陷症失盐型, 单纯男性化型, 非典型失盐型, 皮质醇缺乏型，11-β-羟化酶缺陷症, E. 21-羟化酶缺陷症, 11-β-羟化酶缺陷症, 3β-羟类固醇脱氢酶缺陷症, 17-羟化酶缺陷症,胆固醇碳链酶缺陷症 *2262. 21-羟化酶缺陷症的典型特征是：(难、应用) A. 有明显的男性化或女性假两性畸形、高钾血症、低钠血症，高睾酮血症，高血浆 ACTH、低肾素活性，高 17-羟孕酮 B. 有明显的男性化或女性假两性畸形、高钾血症、低钠血症，高睾酮血症，高血浆 ACTH、低血浆皮质醇，高 17-羟孕酮 C. 有明显的男性化或女性假两性畸形、低钾血症、高钠血症，高睾酮血症，高血浆 ACTH、高肾素活性，高 17-羟孕酮 D. 有明显的男性化或女性假两性畸形、高钾血症、低钠血症，低睾酮血症，高血浆 ACTH、高肾素活性，高醛固酮血症。 E. 有明显的男性化或女性假两性畸形、高钾血症、低钠血症，低睾酮血症，高血浆 ACTH、高肾素活性，低醛固酮血症。 2263.挑选出下列项目中符合嗜铬细胞瘤者：(中、理解) A．收缩压与舒张压均升高，高血压可呈间歇性或持续性发作． B．所谓 Sipple 综合征是本症与慢性甲状腺炎的合并。 C．尿中肾上腺素，去甲肾上腺素增多，但 VMA 量不增多。 D．酚妥拉明（regitine）试验，可用于阵发性者，为激发试验。 E．90%的嗜铬细胞瘤位于肾上腺皮质内。 *2264.患者于切除嗜铬细胞瘤后即刻发生低血压，应立即采用下列哪种治疗？(难、应用) A.皮质类固醇 B.盐皮质激素

C.α-肾上腺素能受体兴奋剂 Dβ肾上腺素能受体兴奋剂 E输血或输血浆 265诊断嗜铬细胞瘤最好的初筛试验是:(中、理解) A.酚妥拉明试验 B.组胺试验 C测定24小时尿中VMA D肾动脉造影 E测定血中儿茶酚胺 2266. A 42-year-old white man comes in with a 5-month history of episodes associated with headaches, palpitations along with chest pain, and blurring of his vision He had seen his family physician on several occasions with no abnormality noted on physical exam. However, he had one on the episodes when leaving his family physician's office on his last visit, and the nurse, who checked his blood pressure of 190/110mmHg, with his usual blood pressure being 130/70 mmh His family physician referred him to you and told the patient that he had a 'glandular disorder The patient's phy sical examination is unremarkable, with a blood pressure of 126/85mmHg Because he has been having one or two episodes a week, ambulatory blood pressure monitoring is done, revealing his blood pressure rising from approximately 140/80 to 220/130 mmHg before returning to normal after the episode resolves. Six days after his last paroxysm, the patient has serum catecholamines properly collected, revealing a serum norepinephrine level of 200pg per milliliter and an epinephrine level of 30pg per milliliter(normal: norepinephrine 220pg per milliliter and an epinephrine 35). Your best interpretation of the above test results in the context of this patient' symptoms and objective findings is(易、应用) A. The above biochemical data exclude a pheochromyuocytoma B. The above biochemical data do not exclude pheochromocytoma because some patients with pheochromocytoma may have normal plasma catecholamine levels when they are asymptomatic and normotensive C. A 24-hour urine measure of vanillylmandelic acid(VMA), metanephrine, and catecholamine levels that is normal during an asymptomatic phase would absolutely exclude pheochromocytoma. D. None of the above E. All of the above 2267. A 34-year-old white man gives a l-year history of sudden onset of episodes of headache followed by palpitations and diaphoresis and a feeling of doom. These episodes initially were occurring about once every 2 weeks but now are occurring once every 3 to 4 days. They typically last 30 to 45 minutes. Recently, during an episode that led him to go to the emergency room, it was noted that his blood pressure was 190/130mmHg. He was given diazepam and, after the episode was over, his blood pressure was 140/96mmHg In your office, exam reveals a blood pressure of 144/98mmHg without orthostatic drop and a pulse of 90 beats per minute(regular) Physical exam otherwise is unremarkable except for a 3-cm nodule in the left lobe of the thyroid of which the patient was not aware. Which of the following statements is/are true with regard to this patient' s history and clinical findings?(易、应用) A 24-hr urine for VMA, metanephrines, and catecholamines would be expected to be elevated in this patient, if done after a spell as described above B Family history of endocrine-related disorders, including pheochromocytoma thyroid cancer, and/or hyperparathroidism, would be expected

C.α-肾上腺素能受体兴奋剂 D.β-肾上腺素能受体兴奋剂 E.输血或输血浆 2265.诊断嗜铬细胞瘤最好的初筛试验是：(中、理解) A.酚妥拉明试验 B.组胺试验 C.测定 24 小时尿中 VMA D.肾动脉造影 E.测定血中儿茶酚胺 2266. A 42-year-old white man comes in with a 5-month history of episodes associated with headaches, palpitations along with chest pain, and blurring of his vision. He had seen his family physician on several occasions with no abnormality noted on physical exam. However, he had one on the episodes when leaving his family physician’s office on his last visit, and the nurse, who checked his blood pressure of 190/110mmHg, with his usual blood pressure being 130/70 mmHg. His family physician referred him to you and told the patient that he had a ‘glandular disorder.’ The patient’s physical examination is unremarkable, with a blood pressure of 126/85mmHg. Because he has been having one or two episodes a week, ambulatory blood pressure monitoring is done, revealing his blood pressure rising from approximately 140/80 to 220/130 mmHg before returning to normal after the episode resolves. Six days after his last paroxysm, the patient has serum catecholamines properly collected, revealing a serum norepinephrine level of 200pg per milliliter and an epinephrine level of 30pg per milliliter(normal: norepinephrine < 220pg per milliliter and an epinephrine < 35). Your best interpretation of the above test results in the context of this patient’s symptoms and objective findings is（易、应用） A. The above biochemical data exclude a pheochromyuocytoma B. The above biochemical data do not exclude pheochromocytoma because some patients with pheochromocytoma may have normal plasma catecholamine levels when they are asymptomatic and normotensive. C. A 24-hour urine measure of vanillylmandelic acid(VMA), metanephrine, and catecholamine levels that is normal during an asymptomatic phase would absolutely exclude pheochromocytoma. D. None of the above E. All of the above 2267. A 34-year-old white man gives a 1-year history of sudden onset of episodes of headache followed by palpitations and diaphoresis and a feeling of doom. These episodes initially were occurring about once every 2 weeks but now are occurring once every 3 to 4 days. They typically last 30 to 45 minutes. Recently, during an episode that led him to go to the emergency room, it was noted that his blood pressure was 190/130mmHg. He was given diazepam and, after the episode was over, his blood pressure was 140/96mmHg. In your office, exam reveals a blood pressure of 144/98mmHg without orthostatic drop and a pulse of 90 beats per minute (regular). Physical exam otherwise is unremarkable except for a 3-cm nodule in the left lobe of the thyroid, of which the patient was not aware. Which of the following statements is/are true with regard to this patient’s history and clinical findings? （易、应用） A 24-hr urine for VMA, metanephrines, and catecholamines would be expected to be elevated in this patient, if done after a spell as described above. B.Family history of endocrine-related disorders, including pheochromocytoma, thyroid cancer, and/or hyperparathroidism, would be expected