臨床醫(yī)學(xué)英語

　　Most patients who have a haematemesis are in no doubt that the blood was vomited. However, blood discovered in the mouth may have originated from the postnasal space or lower respiratory tract. This can cause confusion unless time is taken to elicit an accurate history. The haematemesis may consist either of fresh blood mixed with gastric fluid or changed blood in the form of “coffee grounds”. All such patients should be referred to hospital for admission because haematemesis indicates a recent haemorrhage.

　　The patient’s estimate of how much blood has been vomited is seldom helpful in assessing the true severity of the bleed. In contrast, vomitus saved by the patient or produced in the presence of the practitioner is a useful guide. Haematemesis may be accompanied by melaena but because most patients who vomit blood rapidly seek medical attention, it is not always initially present. If no stool has been passed, rectal examination may reveal melaena. This can sometimes be helpful when there is doubt about the validity of haematemesis. Malaena without haematemesis often indicates a less severe bleed. However, when melaena is fresh or has been present for 3 days or less, admission to hospital is still required. A patient with a longer history of melaena who is not anaemic and remains otherwise healthy does not necessarily require admission, providing early investigation can be arranged. Confusion can sometimes arise in patients taking iron or bismuth containing preparations because they both cause darkening of the stool. Neither gives a positive occult blood test.

　　46. According to the above passage, which of the following statements is TRUE?

　　A) All blood discovered in the mouth was vomited.

　　B) Most blood discovered in the mouth was vomited.

　　C) All blood discovered in the mouth originated from the postnasal space or lower respiratory tract.

　　D) Most blood discovered in the mouth originated from the postnasal space or lower respiratory tract.

　　47. According to the above passage, what may the haematemesis consist of?

　　A) Fresh blood mixed with “coffee grounds”.

　　B) Fresh blood in the form of “coffee grounds”.

　　C) Changed blood mixed with “coffee grounds”.

　　D) Changed blood in the form of “coffee grounds”.

　　48. _______ is usually helpful in assessing the true severity of the haemorrhage.

　　A) The patient’s estimate of how much blood has been vomited.

　　B) The patient’s estimate of how much food has been vomited.

　　C) The vomitus.

　　D) The melaena.

　　49. According to the above passage, which of the following statements is TRUE?

　　A) Haematemesis without malaena often indicates a less severe bleed.

　　B) Haematemesis with malaena often indicates a less severe bleed.

　　C) Malaena without haematemesis often indicates a less severe bleed.

　　D) Malaena with anaemia often indicates a less severe bleed.

　　50.Under which of the following conditions the patient should be referred to hospital for admission?

　　A) When melaena is in the form of “coffee grounds”.

　　B) When melaena is fresh.

　　C) When anaemia is present.

　　D) When the stool is dark.

　　Passage 3

　　For surgery to be curative, it must be performed before the cancer has spread into organs and tissues that cannot be safely removed. Since the late 19th century increasingly radical operations for cancer have become standard. Despite the increasing extent of these procedures, risk has been reduced by improvements in surgical techniques, anesthesiology, and preoperative and postoperative care, especially in the control of infection. Heart-lung pumps, artificial kidneys, and methods of maintaining electrolyte balance and metabolic equilibrium have permitted patients with impaired cardiovascular and kidney functions or poor general metabolism to survive cancer surgery.

　　Major advances have been made in the restoration of structures altered by cancer surgery and in the rehabilitation of people who have undergone radical surgery. Patients undergoing certain surgical procedures for cancer of the colon or rectum, for instance, can be equipped with simple devices for the elimination of solid waste. For patients with cancer of the head and neck, the use of grafting methods and of tissue flaps make it possible to apply reconstructive techniques at the time the cancer is removed.

　　Rehabilitation of the patient also plays an important role. Women who have extensive surgery for breast cancer are given treatment for restoration of muscle tone needed for movement of the arms. Progress has also been made in teaching new mechanisms of speech to people who have undergone surgical removal of the larynx.

　　In addition to saving lives by eradicating cancer, surgery also may improve the remaining months or years of life for persons whose cancers cannot be eradicated, restoring comfort and a sense of usefulness. When severe pain accompanies cancer, surgery may bring relief by severing the nerve pathways that carry the painful sensations. In addition, surgery is sometimes necessary to treat abscesses resulting from either the tumour or infection and to relieve intestinal obstructions.

　　Surgery is also valuable as a preventive measure in controlling cancer. It may be used to elimination precancerous conditions in the mouth, chronic ulcers (ulcerative colitis) that may lead to cancer of the colon, and certain precancerous polyps in the colon and rectum. It may be used to remove burn scars that may lead to cancer, precancerous nodules in the thyroid gland, and certain precancerous pigmented moles.

　　51. The first paragraph is mainly about _________.

　　A) the increasingly radical operations for cancer

　　B) the rapid improvement of cancer surgery

　　C) the improvements in surgical techniques

　　D) the standardized cancer surgery

　　52. Which of the following statements is true according to this passage?

　　A) The structures altered by cancer surgery can hardly be restored

　　B) Simple devices for the elimination of solid waste have been designed for breast cancer patients

　　C) Surgery may help alleviate the sufferings of the incurable cancer patients

　　D) Surgery is an effective means to restore muscle tone

　　53. According to this passage, which of the following statements is not true?

　　A) Methods of maintaining homeostasis is used to help the cancer patients to be operated.

　　B) The colon cancer patients can be equipped with devices for the elimination of fluid.

　　C) The neck cancer patients can undergo a transplant during the cancer surgery.

　　D) Cancer surgery can be used to help the patients to be more positive to life.

　　54. The underlined word “It” in the last paragraph refers to _______

　　A) surgery B) a preventive measure

　　C) to remove burn scars D) that may lead to cancer

　　55. The proper title for this passage should be ______.

　　A) Controlling cancer B) Eradicating Cancer

　　C) Cancer surgery D) Rehabilitation of Cancer Patients

　　Passage 4

　　A big advantage of using genetic engineering to produce drugs is that it’s possible to mass-produce chemicals that might otherwise be difficult and costly to extract, or simply unavailable by conventional means. Another important advantage is that drugs produced in this way are pure and, if made using human genes, fully compatible with use in people.

　　For example, before engineered bacteria were cloned to manufacture human insulin, the main source of this hormone (used to treat diabetes) was the pancreas of cattle or pigs. Although similar to human insulin, animal insulin is not identical and causes allergic reactions in some patients. The human protein produced by bacteria with recombinant DNA, however, has no such effect.

　　To take another example, vaccines against disease are traditionally prepared from killed or “disarmed” pathogens (disease-causing microbes). They are effective in the vast majority of people, but a small percentage of the population have allergic reactions to vaccines. There is also a very small risk of vaccine organisms reactivating to their former pathogenic state. Genetically engineered vaccines are safer because they contain no living organisms — only the proteins that stimulate the body to develop immunity.

　　Vaccines are the second-largest category of over 200 drugs now being produced by American pharmaceutical companies using biotechnology. Other products include hormones, inter

　　ferons, blood-clotting factors, antisense molecules, and enzymes. Most of these drugs are still undergoing clinical testing and are designed to combat cancer, AIDS, asthma, diabetes, heart disease, Lyme disease, multiple sclerosis, rheumatoid arthritis, and viral infections.

　　But the bottom line is that mapping and even sequencing genes is only a beginning. That knowledge alone won’t tell us the gene’s functions. Of the 2,000 or so genes whose locations are mapped today, we know the functions of only a few hundred. And knowing the functions won’t tell us how those functions are actually carried out — how genes are expressed and what the biochemical steps are between the coding for a protein and the symptoms of a disease.

　　Although advancing knowledge is rapidly closing in on these areas, we needn’t worry just yet about having all these secrets of life.

　　56. What makes it so successful to use genetic engineering to produce drugs?

　　A) mass-production at a low cost B) compatibility

　　C) purity D) all of the above

　　57. Human insulin has an advantage over animal insulin in _______.

　　A) dosage B) rejection

　　C) compatibility D) all of the above

　　58. What makes genetically engineered vaccines safely acceptable to those who are allergic to traditional ones?

　　A) capable of developing immunity

　　B) contributive to immune potency

　　C) full of “disarmed ” pathogens

　　D) free of living organisms

　　59. What researchers have done, according to the author, is far from enough in ____________.

　　A) mapping and sequencing genes

　　B) fully understanding genes’ functions and expressions

　　C) genes’ expressions making sense of the biochemical mechanisms

　　D) all of the above

　　60. At the end, the author is trying to tell us that the fear of having all the secrets of life is ________.

　　A) misleading B) impossible

　　C) reasonable D) unnecessary