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 expectedC.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