2026年全国医学英语水平考试(METS二级)历年参考题库含答案详解

2026年全国医学英语水平考试(METS二级)历年参考题库含答案详解PartIListeningComprehension(30points)SectionAShortDialogues—SingleChoice(1–10,1pointeach)Directions:Youwillheartenshortdialogues.Eachdialogueisfollowedbyonequestion.ChoosethebestanswerfromthefouroptionsmarkedA,B,CandD.YouwillheareachdialogueONCEONLY.1.M:Theradiologistsaystheopacityintherightupperzonehasn’tchangedsincelastmonth.W:That’sreassuring;wecanrepeattheCXRinanothereightweeksinsteadoffour.Q:Whatwillthewomanprobablydonext?A.OrderaCTscanimmediately.B.Scheduleafollow-upchestX-rayineightweeks.C.Startempiricalanti-TBtherapy.D.Referthepatienttoathoracicsurgeon.Answer:B2.W:HisserumNais128mmol/L,K3.2mmol/L,andhe’sonfurosemide.M:Let’sswitchtoapotassium-sparingdiureticandrestrictfreewater.Q:Whatelectrolyteabnormalityaretheymostconcernedabout?A.HypernatraemiaB.HypokalaemiaC.HyperkalaemiaD.HypocalcaemiaAnswer:B3.M:Dowehaveinformedconsentforthebronchoscopy?W:Yes,butthepatientwantsherdaughtertosign;shehasdurablepowerofattorney.Q:Whatisthestatusofthedaughter?A.Nextofkinwithoutdecision-makingauthorityB.LegallyauthorisedsurrogateC.WitnessonlyD.EmergencyguardianappointedbycourtAnswer:B4.W:Therapidstreptestisnegative,buttheCentorscoreis4.M:I’llstillprescribeamoxicillin,andwe’llculturethethroat.Q:Whatistheman’sprimaryreasonforantibiotics?A.PositivecultureB.HighclinicalprobabilityC.PatientinsistenceD.HospitalpolicyAnswer:B5.M:ThecardiacMRIshowslategadoliniumenhancementinthemid-walloftheleftventricle.W:Thatpatternsuggestsnon-ischaemicaetiology.Q:Whatdiagnosisaretheyconsidering?A.ViralmyocarditisB.ST-elevationMIC.PulmonaryembolismD.AorticstenosisAnswer:A6.W:Theneonate’sbilirubinis18mg/dLat36h,bloodtypeA+;motherisO+.M:Let’sstartphototherapyandcheckthedirectCoombstest.Q:Whatconditionaretheyrulinginorout?A.ABOincompatibilityB.BiliaryatresiaC.PhysiologicaljaundiceD.Crigler–NajjarsyndromeAnswer:A7.M:TheD-dimeris1200µg/L,Wellsscore2.W:We’lldoaDopplerultrasound;withholdanticoagulationuntilthen.Q:Whatistheprobablenextstep?A.CTPAB.V/QscanC.Lower-limbcompressionultrasonographyD.PulmonaryangiographyAnswer:C8.W:TheHbA1cdroppedfrom9.8%to7.1%aftersixmonthsondulaglutide.M:Excellent,butweneedtomonitorlipase;hehasahistoryofpancreatitis.Q:Whatadverseeffectaretheywatchingfor?A.AcutepancreatitisB.KetoacidosisC.ThyroidC-cellcarcinomaD.SeveregastroparesisAnswer:A9.M:Thepartogramshowscervicaldilatation4cm,station–1,fivehoursagoitwas3cm.W:Wehaveaprolongedlatentphase;let’saugmentwithoxytocin.Q:Whatisthediagnosis?A.ArrestofdescentB.ProtractiondisorderC.FailuretoprogressinlatentphaseD.PrecipitatelabourAnswer:C10.W:Theankle-brachialindexis0.6ontheleftand1.0ontheright.M:Referhimforsupervisedexerciseandcilostazol.Q:Whatconditiondoesthemanmostlikelyhave?A.CriticallimbischaemiaB.IntermittentclaudicationC.CellulitisD.DeepvenousinsufficiencyAnswer:BSectionBLongDialogue—SingleChoice(11–15,2pointseach)Directions:Youwillhearonelongdialoguebetweenaresidentandanattending.Choosethebestanswer.ThedialoguewillbeplayedTWICE.[Audio:discussionona55-year-oldmanwithdecompensatedcirrhosis]11.Whatprecipitatedthecurrentadmission?A.SpontaneousbacterialperitonitisB.HepatorenalsyndromeC.VaricealbleedD.HepaticencephalopathyAnswer:A12.Whichantibioticwaschosenforprophylaxis?A.NorfloxacinB.CeftriaxoneC.MetronidazoleD.VancomycinAnswer:B13.Whatisthetargetmeanarterialpressureinthemanagementofhepatorenalsyndrome?A.≥55mmHgB.≥65mmHgC.≥75mmHgD.≥85mmHgAnswer:B14.Whichscoringsystemdidtheyusetoestimatethree-monthmortality?A.MELD-NaB.Child–PughC.APACHEIID.SOFAAnswer:A15.TheattendingrecommendsTIPSforwhichindication?A.RefractoryascitesB.AcutevaricealbleedingC.HepatopulmonarysyndromeD.PortopulmonaryhypertensionAnswer:ASectionCMini-lecture—GapFilling(16–25,1pointeach)Directions:Completethenotes.UseNOMOREthanTHREEwordsforeachblank.Thelectureison“InterpretationofArterialBloodGases”.16.Thefirststepistoassesswhetherthesamplewas__________.Answer:properlyobtained17.APaCO₂belowthereferencerangeindicates__________.Answer:respiratoryalkalosis18.IfpHandPaCO₂moveinthe__________direction,theprimarydisorderismetabolic.Answer:same19.Thecompensatoryresponseformetabolicacidosisis__________hyperventilation.Answer:respiratory20.Winter’sformulapredictsexpectedPaCO₂as__________mmHg.Answer:1.5×HCO₃+821.Ananiongapabove__________mmol/Lisconsideredabnormal.Answer:1222.Inapatientwithketoacidosis,thedeltagapequals__________.Answer:ΔAG–ΔHCO₃23.Amixeddisorderispresentwhencompensationis__________orovercorrected.Answer:inadequate24.Thebaseexcessisaffectedby__________administration.Answer:albumin25.AlwayscorrelateABGfindingswith__________status.Answer:clinicalPartIIVocabulary&Structure(20points)SectionASingleChoice(26–35,1pointeach)Choosethewordorphrasethatbestcompletesthesentence.26.Thepatient’sdyspnoeawas__________totransientmyocardialischaemia.A.attributedB.contributedC.referredD.impliedAnswer:A27.Thesurgeonapplieda__________haemostattothebleedingvessel.A.mosquitoB.KellyC.KocherD.AllisAnswer:B28.The__________phaseofwoundhealingischaracterisedbyneovascularisation.A.lagB.proliferativeC.inflammatoryD.maturationAnswer:B29.Thenurseaspirated5mLof__________fluidfromthenasogastrictube.A.biliousB.serousC.sanguineousD.chylousAnswer:A30.Thepatientwasstartedona__________dietaftertheWhippleprocedure.A.residue-freeB.high-proteinC.carbohydrate-richD.ketogenicAnswer:A31.The__________testisusedtodiagnosecarpaltunnelsyndrome.A.PhalenB.LachmanC.McMurrayD.ApleyAnswer:A32.The__________ratioisamarkeroffetallungmaturity.A.L/SB.N/TC.A/GD.B/CAnswer:A33.Thepatientdeveloped__________afterreceivingheparinfor5days.A.HITB.DICC.ITPD.TTPAnswer:A34.The__________catheterispreferredforlong-termparenteralnutrition.A.PICCB.CoudéC.FoleyD.FogartyAnswer:A35.The__________signispositiveinmeningitis.A.BrudzińskiB.MurphyC.ChvostekD.TrousseauAnswer:ASectionBClozeTest(36–45,1pointeach)Choosethebestwordtofillintheblank.The62-year-oldmanpresentedwithacute-onsetchestpainradiatingtotheback.CTangiographyrevealedanintimalflap__36__theascendingaorta.Emergencysurgerywas__37__withintwohours.Duringcardiopulmonarybypass,thesurgeonperformeda__38__graftreplacementoftheaorticroot.Post-operatively,thepatientdevelopedcompleteheartblockrequiring__39__pacemakerimplantation.Histologyshowed__40__degenerationofthemedia.Geneticscreeningidentifiedamutationinthe__41__gene.Lifelong__42__blockadewasrecommendedtoreduceaorticshearstress.Thepatientwasadvisedtoavoid__43__sports.Surveillanceimagingwasscheduledevery__44__months.Theprognosisremainsguardedduetotheriskof__45__dissection.36.A.inB.onC.withinD.alongAnswer:A37.A.initiatedB.indicatedC.inducedD.inhibitedAnswer:A38.A.DacronB.Gore-TexC.bovineD.autologousAnswer:A39.A.dual-chamberB.epicardialC.transcutaneousD.demandAnswer:A40.A.cysticB.hyalineC.fibrinoidD.amyloidAnswer:A41.A.FBN1B.TGFBR2C.SMAD3D.COL3A1Answer:A42.A.beta-adrenergicB.calcium-channelC.ACED.alpha-adrenergicAnswer:A43.A.competitiveB.isometricC.aerobicD.aquaticAnswer:B44.A.threeB.sixC.nineD.twelveAnswer:B45.A.distalB.proximalC.recurrentD.iatrogenicAnswer:CPartIIIReadingComprehension(30points)SectionAMultipleChoice(46–55,2pointseach)Passage1(Questions46–49)Chronicthrombo-embolicpulmonaryhypertension(CTEPH)isalatecomplicationofacutepulmonaryembolism.Thepathophysiologyinvolvesunresolvedthrombithatbecomefibroticandobliteratepulmonaryarteries,leadingtoincreasedpulmonaryvascularresistance.Diagnosisrequiresameanpulmonaryarterypressure≥25mmHgwithpersistentperfusiondefectsonV/Qscanandevidenceofthrombo-embolicobstructiononCTpulmonaryangiographyorconventionalangiography.Surgicalpulmonaryendarterectomyremainsthetreatmentofchoiceforaccessibledisease,withaperi-operativemortality<5%inexperiencedcentres.Forinoperablepatients,riociguat,asolubleguanylatecyclasestimulator,improvesexercisecapacityandhaemodynamics.Balloonpulmonaryangioplastyisanemergingoption.46.WhichfindingisessentialforthediagnosisofCTEPH?A.ElevatedNT-proBNPB.PerfusiondefectsonV/QscanC.RightheartcatheterisationshowingPCWP>15mmHgD.PositiveD-dimerAnswer:B47.Whatisthefirst-linetreatmentforoperableCTEPH?A.RiociguatB.WarfarinC.PulmonaryendarterectomyD.LungtransplantationAnswer:C48.Whichdrugclassdoesriociguatbelongto?A.Endothelin-receptorantagonistB.PDE-5inhibitorC.SolubleguanylatecyclasestimulatorD.ProstacyclinanalogueAnswer:C49.Whatistheapproximateperi-operativemortalityathigh-volumecentres?A.<1%B.<5%C.10%D.15%Answer:BPassage2(Questions50–53)Non-alcoholicfattyliverdisease(NAFLD)encompassesaspectrumfromsimplesteatosistosteatohepatitis(NASH)andcirrhosis.Insulinresistanceisthekeypathogenicfactor.Asubsetofpatientsprogresstohepatocellularcarcinoma(HCC)evenwithoutcirrhosis.CurrentguidelinesrecommendscreeningforHCCeverysixmonthsinNAFLDpatientswithcirrhosis.Thepreferredmodalityisabdominalultrasoundwithorwithoutalpha-fetoprotein.Weightlossof≥10%throughlifestylemodificationorbariatricsurgerycanleadtohistologicalregressionofNASH.Nopharmacologicalagenthasreceivedregulatoryapproval,althoughpioglitazoneandvitaminEhaveshownefficacyinselectedcohorts.50.WhatistheprincipaldriverofNAFLDpathogenesis?A.AutoimmunityB.InsulinresistanceC.ViralinfectionD.AlcoholconsumptionAnswer:B51.InwhichgroupisHCCsurveillancerecommended?A.AllNAFLDpatientsB.NAFLDwithBMI>30kg/m²C.NAFLDwithadvancedfibrosisorcirrhosisD.NAFLDwithdiabetesonlyAnswer:C52.Whichinterventionhasdemonstratedhistologicalimprovement?A.5%weightlossB.7%weightlossC.≥10%weightlossD.Metformin2gdailyAnswer:C53.Whichmedicationhasevidenceofefficacyinnon-cirrhoticNASH?A.MetforminB.VitaminEC.SitagliptinD.AtorvastatinAnswer:BPassage3(Questions54–55)A28-year-oldprimigravidaat29weeks’gestationpresentswithsevereheadacheandblurredvision.Bloodpressureis165/110mmHg,platelets88×10⁹/L,AST92IU/L,andproteinuria3+.Thefetalheartratetracingshowsrecurrentlatedecelerations.Themostlikelydiagnosisisseverepre-eclampsiawithHELLPsyndrome.Immediatemanagementincludesintravenouslabetaloltocontrolbloodpressure,magnesiumsulfateforseizureprophylaxis,anddeliveryaftermaternalstabilizationregardlessofgestationalage.54.WhichfindingisNOTpartoftheHELLPcriteria?A.HaemolysisB.ElevatedliverenzymesC.LowplateletsD.ElevatedINRAnswer:D55.Whatisthedefinitivetreatment?A.Expectantmanagementuntil34weeksB.AntihypertensivetherapyaloneC.DeliveryofthefetusD.PlasmaexchangeAnswer:CSectionBMatchingParagraphHeadings(56–60,2pointseach)Directions:Choosethebestheading(i–ix)forparagraphsA–Eofthepassage.i.Epidemiologicaltrendsii.Diagnosticbiomarkersiii.Pathophysiologyofcartilagedegradationiv.Surgicaloptionsv.Non-pharmacologicalmanagementvi.Pharmacologicalpipelinevii.Economicburdenviii.Riskfactorsix.FutureresearchdirectionsParagraphA:Theincidenceofsymptomatickneeosteoarthritishasdoubledoverthepasttwodecades,parallelingrisingobesityratesandageingpopulations.Answer:iParagraphB:Excessivemechanicalloadingtriggerschondrocyte-mediatedbreakdownoftypeIIcollagenandaggrecan,leadingtocartilagematrixloss.Answer:iiiParagraphC:Ameta-analysisshowedthatland-basedexerciseprogrammesreducepainby30%andimprovefunctionscoreswithinsixweeks.Answer:vParagraphD:Sprifermin,arecombinanthumanfibroblastgrowthfactor18,isunderinvestigationforitsdisease-modifyingpotentialinphaseIIItrials.Answer:viParagraphE:CombiningMRI-basedcartilagemorphometrywithserumCOMPlevelsmayenhanceearlydiagnosisbeforeradiographicchangesoccur.Answer:iiPartIVTranslation(20points)SectionAEnglishtoChinese(61,10points)TranslatethefollowingparagraphintoChinese.“Acutekidneyinjury(AKI)isasuddendecreaseinrenalfunctionwithin48hours,manifestedbyanabsoluteincreaseinserumcreatinineof≥0.3mg/dLorapercentageriseof≥50%.Earlyrecognitioniscrucialbecauseevenminorelevationsareassociatedwithincreasedin-hospitalmortality.Managementhingesonidentifyingandtreatingtheunderlyingcause,ensuringadequaterenalperfusion,andavoidingnephrotoxicagents.Renalreplacementtherapyshouldbeinitiatedwhenlife-threateningcomplicationssuchasrefractoryhyperkalaemia,severeacidosis,orvolumeoverloadrefractorytodiureticsoccur.”参考译文：急性肾损伤（AKI）指肾功能在48小时内突然下降，表现为血清肌酐绝对值升高≥0.3mg/dL或升幅≥50%。早期识别至关重要，因为即使轻度升高也与住院死亡率增加相关。治疗关键在于明确并处理病因、保证肾脏灌注、避免肾毒性药物。当出现危及生命的并发症（如顽固性高钾血症、严重酸中毒或对利尿剂无效的容量负荷）时，应启动肾脏替代治疗。SectionBChinesetoEnglish(62,10points)TranslatethefollowingparagraphintoEnglish.“对于疑似败血症的成人患者，应在识别后1小时内完成血培养并经验性使用广谱抗生素。液体复苏首选晶体液，30mL/kg体重快速输注。若平均动脉压低于65mmHg，需加用血管活性药物，首选去甲肾上腺素。动态监测乳酸水平可评估治疗效果。”Referenceanswer:“Inadultpatientswithsuspectedsepsis,bloodculturesshouldbeobtainedandempiricbroad-spectrumantibioticsadministeredwithinonehourofrecognition.Crystalloidsarethefluidofchoiceforresuscitation,givenasarapidinfusionof30mL/kg.Ifmeanarterialpressureremainsbelow65mmHg,vasopressorsshouldbeadded,withnorepinephrineasthefirst-lineagent.Seriallactatemeasurementscanbeusedtoassesstheresponsetotherapy.”PartVAppliedWriting(20points)SectionACaseSummary(63,10points)Directions:Youaretheresidentonduty.Writeaconcisecasesummary(80–100words)fortheelectronichealthrecordbasedonthefollowingdata.Patient:45-year-oldmale,BMI32kg/m².Presentingcomplaint:Epigastricpainradiatingtotheback,nausea.Investigations:Serumlipase890U/L(normal<60),triglycerides18mmol/L,CTshowingperipancreaticfatstranding,nonecrosis.Management:AdmittedtoHDU,aggressiveIVfluids,insulininfusion,plasmapheresisforhypertriglyceridaemia.Outcome:Painresolvedin36h,lipasetrendingdown,dischargedonfenofibrateandinsulin.Modelanswer:“45-year-oldobesemanpresentedwithepigastricpainradiatingtothebackandnausea.Investigationsrevealedmarkedlyelevatedlipase(890U/L)andseverehypertriglyceridaemia(18mmol/L).CTconfirmedacuteinterstitialpancreatitiswithoutnecrosis.HewasmanagedinHDUwithaggressiveIVhydration,insulininfusionandplasmapheresis.Symptomsresolvedwithin36hours;lipasedecreased.Dischargedonfenofibrateandinsulinwithoutpatientfollow-up.”SectionBReferralLetter(64,10points)Directions:Writeaformalreferralletter(120–150words)fromDrSmith,GP,toDrLee,gastroenterologist,requestingurgentendoscopyfora58-year-oldwomanwithiron-deficiencyanaemiaandpositivefaecaloccultblood.Modelanswer:DearDrLee,Re:MrsMargaretO’Connor,DOB12/03/1968Iwouldbegratefulifyoucouldarrangeanurgentoesophago-gastro-duodenoscopy.Shehassymptomaticiron-deficiencyanaemia(Hb92g/L,MCV72fL)andpositivefaecaloccultblood.Noovertbleedingormelaena.Pasthistory:RAonNSAIDs.Medications:omeprazole20mgod,methotrexate15mgweekly.Examination:paleconjunctivae,nolymphadenopathy,softabdomen.PleaseruleoutupperGImalignancyandreviewNSAIDuse.Yourssincerely,DrHelenSmith,MBBSPartVIIntegratedClinicalProblem-solving(30points)Case-basedMultipleChoice(65–74,3pointseach)A19-year-oldmanisbroughttotheEDafteramotor-vehiclecrash.Hewasnotwearingaseatbelt.Vitals:BP80/50mmHg,HR130beats/min,RR28breaths/min,SpO₂94%on6LO₂.FASTscanshowsfreefluidinMorrison’spouch.ChestX-rayisunremarkable.PelvicX-rayshowsbilateralsuperiorpubicramifractures.Hereceives2Lcrystalloidwithtransientimprovement.Hishaemoglobinis8.2g/dL.65.Whatisthemostlikelysourceofhaemorrhage?A.SpleniclacerationB.RetroperitonealpelvicvesselsC.MesenterictearD.ThoracicaorticruptureAnswer:B66.Thenextstepinresuscitationshouldbe:A.ImmediatelaparotomyB.Type-specificbloodtransfusionC.ApplicationofpelvicbinderandbloodproductsD.CTabdomenwithcontrastAnswer:C67.WhichvasopressorispreferredifMAPremains<65mmHgafterbloodproducts?A.DopamineB.PhenylephrineC.NorepinephrineD.VasopressinAnswer:C68.WhatratioofplasmatoRBCisrecommendedinmassivetransfusion?A.1:1B.1:2C.1:3D.1:4Answer:A69.Whichinvestigationbestevaluatesactivearterialextravasationinthepelvis?A.FASTscanB.DiagnosticperitoneallavageC.CTangiographyD.MRIAnswer:C70.IfthepatientdevelopsdiffuseoozingintheICU,whichtestshouldbeorderedfirst?A.FibrinogenlevelB.PlateletcountC.ThromboelastographyD.INRAnswer:C71.Bilateralfemoralaccessispreparedforwhichintervention?A.ECMOcannulationB.Angio-embolisationC.Intra-aorticballoonpumpD.DialysiscatheterplacementAnswer:B72.Thepatientbecomesagitatedandhisend-tidalCO₂dropsto20mmHg.Whatistheconcern?A.PulmonaryembolismB.FatembolismC.AirembolismD.HypovolaemicshockAnswer:A73.Whichacid-basepatternisexpectedaftermassivetransfusion?A.RespiratoryacidosisB.MetabolicalkalosisC.MetabolicacidosisD.RespiratoryalkalosisAnswer:C74.Long-termcomplicationofpelvicfractureincludes:A.AvascularnecrosisoffemoralheadB.Post-traumaticosteoarthritisofhipC.MalunioncausingchronicpainD.AlloftheaboveAnswer:DPartVIIShort-answerQuestions(20points)75.(5points)Listfourabsolutecontraindicationstothrombolysisinacuteischaemicstroke.Answer:1.IntracranialhaemorrhageonCT2.Activeinternalbleeding3.Recentmajorsurgerywithin14days4.Plateletcount<100×10⁹/L76.(