2025年医师资格考试医学英语水平测试试卷

2025年医师资格考试医学英语水平测试试卷PartⅠVocabularyandStructure(20items,0.5pointeach,total10points)Directions:Thereare20incompletesentencesinthispart.ForeachsentencetherearefourchoicesmarkedA,B,CandD.ChoosetheONEanswerthatbestcompletesthesentence.1._____referstotheexpectorationofbloodorblood-stainedsputumfromthelungs,whichisacommonsymptomofpulmonarytuberculosis,bronchiectasis,orlungcancer.A.DyspneaB.HemoptysisC.HematemesisD.Epistaxis2.Thepatientwasdiagnosed_____acutemyocardialinfarctionafterserialelectrocardiogramchangesandelevatedtroponinlevelsweredetected.A.ofB.withC.forD.by3.Itisstronglyrecommendedthatpatientswithseverechronicobstructivepulmonarydisease_____annualinfluenzavaccinationtoreducetheriskofacuteexacerbation.A.receiveB.receivesC.receivedD.havereceived4.Whichofthefollowingtermsreferstoasurgicalproceduretoremovethegallbladder,usuallyperformedforsymptomaticgallstones?A.ColectomyB.CholecystectomyC.GastrectomyD.Mastectomy5.Thenewdrug,_____hasbeenapprovedbytheFDAforthetreatmentofrelapsedmultiplemyeloma,showsa37%reductionindiseaseprogressionriskcomparedwithplacebo.A.thatB.whichC.whatD.whose6._____isachronicautoimmunedisorderthatprimarilyaffectsthejoints,causingpersistentpain,swelling,anddeformityifleftuntreated.A.OsteoarthritisB.RheumatoidarthritisC.GoutyarthritisD.Septicarthritis7.Thepatienthasbeenonantihypertensivemedicationfor5years,buthisbloodpressureremains_____abovethetargetlevelof130/80mmHg.A.consistentlyB.consequentlyC.considerablyD.contrarily8.Computedtomography(CT)angiographyofthecoronaryarteriesisanon-invasiveimagingtest_____todetectblockagesinthecoronaryarteries.A.usedB.usingC.touseD.beingused9.Whichofthefollowingisafirst-lineantibioticforthetreatmentofcommunity-acquiredpneumoniainotherwisehealthyadults?A.VancomycinB.AmoxicillinC.ImipenemD.Ceftazidime10.Bythetimethepatientwastransferredtotheintensivecareunit,he_____mechanicalventilationfor48hoursduetoacuterespiratorydistresssyndrome.A.receivedB.hasreceivedC.hadreceivedD.wasreceiving11._____isthemedicaltermforanabnormallylowlevelofglucoseintheblood,whichmaycausesymptomssuchaspalpitations,sweating,andconfusion.A.HyperglycemiaB.HypoglycemiaC.HypercalcemiaD.Hypocalcemia12.Theresearchteamrecruited2,368participants_____wereaged50to75yearswithnopriorhistoryofcardiovasculardiseasefortheprospectivecohortstudy.A.whichB.whoC.whomD./13.Whichofthefollowingimagingmodalitiesismostsensitiveforthediagnosisofacuteischemicstrokewithinthefirst3hoursofsymptomonset?A.Non-contrastCToftheheadB.Magneticresonanceimaging(MRI)withdiffusion-weightedimagingC.CarotidultrasoundD.TranscranialDoppler14.Patientswithrenalimpairmentrequiredoseadjustmentofmetforminbecausethedrugisprimarily_____viathekidneys.A.metabolizedB.absorbedC.excretedD.distributed15.Themainfunctionofredbloodcellsis_____oxygenfromthelungstoallbodytissuesandcarbondioxidebacktothelungsforexhalation.A.transportB.totransportC.transportedD.beingtransported16.Whichofthefollowingtermsdescribesaconditionwheretheplacentaimplantsinthelowerpartoftheuterus,coveringthecervicalos,andmaycausepainlessvaginalbleedinginthethirdtrimester?A.PlacentalabruptionB.PlacentapreviaC.PretermlaborD.Preeclampsia17.Thehospitalhasimplementedaseriesofinfectioncontrolmeasures_____reducetheincidenceofhospital-acquiredinfectionsby20%withinoneyear.A.inordertoB.inadditiontoC.inregardtoD.inspiteof18._____isahighlycontagiousviralinfectionoftherespiratorytract,characterizedbyfever,cough,runnynose,andamaculopapularrash,whichcanbepreventedbyvaccination.A.MeaslesB.MumpsC.RubellaD.Varicella19.Thepatient’sfamilyhistoryissignificantforbreastcancer,withhermotherandtwomaternalaunts_____diagnosedwiththediseasebeforetheageof50.A.beB.areC.beenD.being20.Whichofthefollowingisakeydiagnosticcriterionfortype1diabetesmellitus?A.InsulinresistanceastheprimarypathophysiologicalfeatureB.PresenceofisletcellautoantibodiesindicatingautoimmunedestructionofbetacellsC.Onsetusuallyaftertheageof40yearsD.GoodresponsetooralhypoglycemicagentsPartⅡReadingComprehension(20items,2pointseach,total40points)Directions:Thereare4passagesinthispart.Eachpassageisfollowedby5questionsorunfinishedstatements.ForeachofthemtherearefourchoicesmarkedA,B,CandD.Choosethebestanswer.Passage1Sodium-glucosecotransporter2(SGLT2)inhibitors,originallydevelopedasglucose-loweringagentsfortype2diabetesmellitus(T2DM),havedemonstratedsignificantcardiovascularandrenalbenefitsinmultipleclinicaltrials.Arecent5-yearprospectiverandomizedcontrolledtrial(RCT)publishedin*TheNewEnglandJournalofMedicine*furtherevaluatedthelong-termeffectsofempagliflozininpatientswithT2DMandheartfailurewithreducedejectionfraction(HFrEF),regardlessofbaselineglycemiccontrol.Thetrialenrolled4,823patientsacross12countries,aged40to85years,withleftventricularejectionfraction(LVEF)≤40%andaconfirmeddiagnosisofT2DM(HbA1c7.0%to10.5%onstableglucose-loweringtherapy).Patientswererandomlyassignedina1:1ratiotoreceiveeitherempagliflozin10mgoncedailyorplacebo,inadditiontostandardheartfailuretherapyincludingACEinhibitors,beta-blockers,andmineralocorticoidreceptorantagonists.Theprimarycompositeendpointwascardiovasculardeathorhospitalizationforheartfailure.Overthe5-yearfollow-upperiod,theprimaryendpointoccurredin21.2%ofpatientsintheempagliflozingroup,comparedwith29.6%ofpatientsintheplacebogroup(hazardratio[HR]0.68;95%confidenceinterval[CI]0.59to0.78;P<0.001).Thebenefitwasconsistentacrosssubgroups,includingpatientswithHbA1cbelow7.0%atbaseline,thosewithestimatedglomerularfiltrationrate(eGFR)aslowas30mL/min/1.73m²,andpatientswhohadexperiencedapriormyocardialinfarction.Secondaryendpointsincludedall-causemortality,changeinLVEF,andannualrateofdeclineineGFR.All-causemortalitywas13.8%intheempagliflozingroupversus18.5%intheplacebogroup(HR0.72;95%CI0.61to0.85;P<0.001).Patientsintheempagliflozingroupalsoshoweda6.2percentagepointincreaseinLVEFat2years,comparedwitha2.1percentagepointincreaseintheplacebogroup(P<0.001).TherateofeGFRdeclinewas1.8mL/min/1.73m²peryearslowerintheempagliflozingroupthanintheplacebogroup(P<0.001).Themostcommonadverseeventsintheempagliflozingroupweregenitalmycoticinfections,whichoccurredin8.3%ofpatientscomparedwith2.1%intheplacebogroup(P<0.001).Theincidenceofketoacidosiswaslowbuthigherintheempagliflozingroup(1.2%vs0.4%;P=0.01).Nosignificantdifferencewasobservedintherateofacutekidneyinjurybetweenthetwogroups.Thestudyauthorsconcludedthatempagliflozinsignificantlyreducestheriskofcardiovasculardeathandheartfailurehospitalization,improvescardiacandrenalfunction,andhasanacceptablesafetyprofileinpatientswithT2DMandHFrEFoverlong-termfollow-up,supportingitsuseasafirst-lineagentinthispatientpopulationregardlessofglycemictargets.21.Whatistheprimarypurposeofthestudydescribedinthepassage?A.Tocomparetheglucose-loweringefficacyofempagliflozinandplaceboinT2DMpatientsB.Toevaluatethelong-termeffectsofempagliflozinoncardiovascularandrenaloutcomesinT2DMpatientswithHFrEFC.ToassessthesafetyofSGLT2inhibitorsinpatientswithimpairedrenalfunctionD.Todeterminetheoptimaldoseofempagliflozinforheartfailuretreatment22.Accordingtothepassage,whichofthefollowingpatientswouldbeeligibleforenrollmentinthetrial?A.A38-year-oldmalewithT2DMandHFrEF(LVEF35%)B.A72-year-oldfemalewithT2DMandheartfailurewithpreservedejectionfraction(HFpEF)C.A65-year-oldmalewithT2DM,HFrEF(LVEF38%),andeGFR28mL/min/1.73m²D.A52-year-oldfemalewithT2DM,HFrEF(LVEF35%),andHbA1c8.2%onmetformintherapy23.Theprimarycompositeendpointofthestudyincludes:A.Cardiovasculardeathandall-causemortalityB.HospitalizationforheartfailureandacutekidneyinjuryC.CardiovasculardeathandhospitalizationforheartfailureD.All-causemortalityanddeclineinrenalfunction24.WhichofthefollowingstatementsaboutthestudyresultsisTRUE?A.EmpagliflozinonlyreducedtheprimaryendpointriskinpatientswithHbA1cabove7.0%atbaselineB.TheincreaseinLVEFintheempagliflozingroupwas4.1percentagepointshigherthanintheplacebogroupat2yearsC.TherateofacutekidneyinjurywassignificantlylowerintheempagliflozingroupD.All-causemortalitywasreducedby32%intheempagliflozingroupcomparedwithplacebo25.Whatcanbeinferredfromthelastparagraph?A.EmpagliflozinshouldreplaceallotherheartfailuremedicationsforT2DMpatientswithHFrEFB.GlycemiccontrolisnolongerimportantforT2DMpatientswithheartfailureC.EmpagliflozinprovidesbenefitsbeyondglucoseloweringinT2DMpatientswithHFrEFD.GenitalmycoticinfectionsareacontraindicationfortheuseofempagliflozinPassage2The2024GlobalAntimicrobialResistanceandUseSurveillanceSystem(GLASS)report,releasedbytheWorldHealthOrganization(WHO),highlightsthegrowingthreatofantimicrobialresistance(AMR)toglobalpublichealth,withparticularlyhighratesofresistanceobservedincommonbacterialpathogensthatcausehealthcare-associatedandcommunity-acquiredinfections.Thereportcompileddatafrom127countries,covering8bacterialpathogenscommonlyassociatedwithsevereorlife-threateninginfections:Escherichiacoli,Staphylococcusaureus,Klebsiellapneumoniae,Streptococcuspneumoniae,Neisseriagonorrhoeae,Salmonellatyphi,Pseudomonasaeruginosa,andAcinetobacterbaumannii.Resistancetofirst-lineantibioticswashighestinlow-andmiddle-incomecountries(LMICs),whereaccesstoaffordablesecond-andthird-lineantibioticsisoftenlimited,leadingtohighermortalityratesfromresistantinfections.Keyfindingsfromthereportinclude:1.ForEscherichiacoli,themostcommoncauseofurinarytractinfections,resistancetoampicillinwasreportedin72%ofisolatesglobally,whileresistancetofluoroquinolonesrangedfrom28%inhigh-incomecountries(HICs)to49%inLMICs.Resistancetothird-generationcephalosporins,akeytreatmentoptionforsevereE.coliinfections,wasreportedin23%ofglobalisolates,withratesashighas35%insomeSouthAsiancountries.2.Methicillin-resistantStaphylococcusaureus(MRSA),amajorcauseofskinandsofttissueinfections,sepsis,andpneumonia,accountedfor29%ofallS.aureusisolatesglobally.TheproportionofMRSAwas21%inHICscomparedwith34%inLMICs,thoughsomeHICshavesuccessfullyreducedMRSAratesthroughstrictinfectioncontrolmeasures.3.ForKlebsiellapneumoniae,acommoncauseofhospital-acquiredpneumoniaandbloodstreaminfections,resistancetocarbapenems—oftenconsideredlast-resortantibiotics—wasreportedin12%ofglobalisolates,withratesexceeding25%inpartsofEasternEuropeandSoutheastAsia.Carbapenem-resistantK.pneumoniae(CRKP)isassociatedwithmortalityratesofupto50%inpatientswithbloodstreaminfections.4.Resistancetofirst-linetreatmentforNeisseriagonorrhoeae(gonorrhea)isnowwidespread,withover80%ofcountriesreportingresistancetociprofloxacin,and62%reportingresistancetoazithromycin.Only30%ofcountrieshavewidespreadaccesstoceftriaxone,thecurrentrecommendedfirst-linetreatmentforgonorrhea.Thereportalsonotedthatglobalantibioticconsumptionincreasedby12%between2015and2023,with70%oftheincreaseoccurringinLMICs.Whilepartofthisincreasereflectsimprovedaccesstoessentialantibiotics,asignificantproportionisduetoinappropriateuse,includingoverprescriptionforviralinfections,incorrectdosing,anduseofantibioticsasgrowthpromotersinlivestockfarming.WHOofficialsemphasizethataddressingAMRrequiresaOneHealthapproach,integratinghumanhealth,animalhealth,andenvironmentalhealthmeasures.Keyrecommendedactionsincludestrengtheningsurveillanceofresistantinfections,improvingaccesstorapiddiagnosticteststoguideappropriateantibioticuse,restrictingtheuseofcriticallyimportantantibioticsinagriculture,andacceleratingthedevelopmentofnewantibioticsandvaccines.26.Whatisthemainfocusofthe2024GLASSreport?A.Theglobalincreaseinantibioticconsumptionbetween2015and2023B.ThestatusofantimicrobialresistanceacrossdifferentcountriesandbacterialpathogensC.Theeconomicburdenofantibiotic-resistantinfectionsworldwideD.Thedevelopmentofnewantibioticstotreatresistantinfections27.Accordingtothereport,resistancetothird-generationcephalosporinsinE.coliisolatesishighestinwhichregion?A.EasternEuropeB.SouthAsiaC.SoutheastAsiaD.Sub-SaharanAfrica28.WhichofthefollowingstatementsaboutMRSAisTRUEaccordingtothepassage?A.MRSAaccountsformorethan40%ofS.aureusisolatesinhigh-incomecountriesB.Nohigh-incomecountrieshavebeenabletoreduceMRSAinfectionratesC.MRSAcancausesevereinfectionsincludingsepsisandpneumoniaD.MRSAisprimarilytransmittedthroughcontaminatedfoodandwater29.Theword“last-resort”inParagraph4isclosestinmeaningto:A.mosteffectiveB.finalavailableC.leastexpensiveD.mostwidelyused30.Accordingtothereport,whatisamajorfactorcontributingtotheincreaseinglobalantibioticconsumption?A.ThegrowingglobalprevalenceofchronicdiseasesB.TheexpansionofantibioticuseinlivestockfarmingC.Thedevelopmentofnew,morepotentantibioticsD.ThedeclineinvaccinecoverageforbacterialdiseasesPassage3MessengerRNA(mRNA)technology,whichgainedwidespreadrecognitionduringtheCOVID-19pandemic,isnowbeingrapidlyadaptedforthetreatmentofraregeneticdiseases,withmultiplecandidatesenteringlate-stageclinicaltrialsandthefirstmRNA-basedtherapyforararediseaseapprovedbytheU.S.FoodandDrugAdministration(FDA)inlate2024.Unliketraditionalgenetherapy,whichusesviralvectorstodeliverDNAintoapatient’scellstoreplaceadefectivegene,mRNAtherapydeliverssyntheticmRNAmoleculesthatencodeafunctionalprotein,allowingthepatient’sowncellstoproducethemissingordefectiveproteintemporarily.Thisapproachhasseveralkeyadvantagesovertraditionalgenetherapy:mRNAdoesnotintegrateintothepatient’sgenome,eliminatingtheriskofinsertionalmutagenesis;itcanberapidlymanufacturedatscale;anddosingcanbeeasilyadjustedbasedonpatientresponse,reducingtheriskofoverexpressionofthetargetprotein.ThefirstFDA-approvedmRNAtherapyforararediseaseisdesignedtotreattransthyretin(TTR)amyloidosis,aprogressiveandoftenfatalconditioncausedbymutationsintheTTRgenethatleadtothebuildupofmisfoldedTTRproteinintheheart,nerves,andotherorgans.ThetherapyworksbydeliveringmRNAencodingamodified,stableformoftheTTRproteinthatdoesnotmisfold,alongwithasmallinterferingRNA(siRNA)componentthatsilencestheproductionofthemutantTTRprotein.Inaphase3trialinvolving284patientswithhereditaryTTRamyloidosiswithpolyneuropathy,78%ofpatientswhoreceivedthetherapyshoweda50%orgreaterreductioninneuropathysymptomscoresafter12months,comparedwith12%ofpatientsintheplacebogroup(P<0.001).Commonadverseeventsincludedmildtomoderateinjectionsitereactions,fatigue,andheadache,whichresolvedwithin48hours.Morethan30othermRNAtherapiesforrarediseasesarecurrentlyinclinicaldevelopment,targetingconditionsincludingphenylketonuria(PKU),cysticfibrosis,spinalmuscularatrophy(SMA),andvariouslysosomalstoragedisorders.Forexample,anmRNAtherapyforPKU,whichiscausedbyadeficiencyofthephenylalaninehydroxylase(PAH)enzymethatbreaksdowntheaminoacidphenylalanine,hasshownpromisingresultsinaphase2trial.Patientsreceivingthetherapyhada38%reductioninbloodphenylalaninelevelsafter8weeksoftreatment,with62%ofpatientsachievinglevelswithinthenormalrange,comparedwith0%intheplacebogroup.Despitetheseadvances,severalchallengesremainformRNAtherapyinrarediseasetreatment.Theprimarychallengeisdelivery:mRNAmoleculesarefragileandeasilydegradedbynucleasesinthebloodstream,sotheymustbepackagedinlipidnanoparticles(LNPs)toreachtargettissues.MostcurrentLNPformulationsprimarilytargettheliver,whichlimitsthetreatmentofdiseasesaffectingotherorganssuchasthebrain,lungs,ormuscles.Anotherchallengeistheneedforrepeateddosing,asmRNAtherapyonlyprovidestemporaryproteinproduction—mostcurrentcandidatesrequiredosingevery2to4weeks,whichcanbeburdensomeforpatientsandincreasetreatmentcosts.Researchersareactivelyworkingtoaddressthesechallenges,includingdevelopingtissue-specificLNPformulationsthatcantargetorgansbeyondtheliver,andmodifyingmRNAmoleculestoextendtheirhalf-lifeandreducedosingfrequency.Withcontinuedinvestmentandtechnologicaladvancement,mRNAtherapyisexpectedtobecomeastandardtreatmentoptionformanyraregeneticdiseasesbytheendofthedecade.31.WhatisthemaindifferencebetweenmRNAtherapyandtraditionalviralvectorgenetherapy?A.mRNAtherapyismoreexpensivetomanufacturethantraditionalgenetherapyB.mRNAtherapydoesnotintegrateintothepatient’sgenome,whiletraditionalgenetherapydoesC.mRNAtherapyprovidespermanentcorrectionofthegeneticdefect,whiletraditionalgenetherapydoesnotD.mRNAtherapycanonlytargetliverdiseases,whiletraditionalgenetherapycantargetallorgans32.ThefirstFDA-approvedmRNAtherapyforrarediseaseisusedtotreat:A.SpinalmuscularatrophyB.CysticfibrosisC.TransthyretinamyloidosisD.Phenylketonuria33.Accordingtothepassage,whatistheresultofthephase3trialfortheTTRamyloidosismRNAtherapy?A.Morethan70%ofpatientsachievednormalTTRproteinlevelsafter12monthsB.78%ofpatientshada50%orgreaterreductioninneuropathysymptomscoresC.ThetherapycompletelyeliminatedmisfoldedTTRproteinin90%ofpatientsD.Adverseeventswerereportedinlessthan5%ofpatientsreceivingthetherapy34.WhatisthebiggestchallengefacingmRNAtherapyforrarediseasescurrently?A.HighmanufacturingcostB.RiskofinsertionalmutagenesisC.DifficultyindeliveringmRNAtotargettissuesbeyondtheliverD.Lackofregulatoryapprovalpathways35.Whichofthefollowingcanbeinferredfromthepassage?A.mRNAtherapywillreplaceallothertreatmentoptionsforrarediseasesby2030B.mRNAtherapyforPKUhasbeenapprovedbytheFDAC.PatientsreceivingmRNAtherapyforTTRamyloidosisrequireonlyonedosetoachievelong-termbenefitsD.ResearchersareworkingonnewLNPformulationstoexpandtherangeoftreatablediseasesPassage4The2024ChineseGuidelinesforthePreventionandTreatmentofHypertension,releasedbytheChineseHypertensionLeagueandtheNationalCenterforCardiovascularDiseases,wereformallypublishedin*ChineseMedicalJournal*inlate2024,incorporatingthelatestevidencefromdomesticandinternationalclinicaltrialsandadaptingtothecharacteristicsofhypertensionintheChinesepopulation.Theguidelinesrepresentamajorupdatefromthe2018version,withkeychangesindiagnosticthresholds,riskstratification,andtreatmentstrategies.Oneofthemostnotableupdatesistheadjustmentofthediagnosticthresholdforhypertensioninadultsaged18to64yearsfrom140/90mmHgto135/85mmHg,aligningwithrecentevidencethatbloodpressureabove135/85mmHgisassociatedwithasignificantlyincreasedriskofcardiovasculareventsintheChinesepopulation.Foradultsaged65yearsandolder,thediagnosticthresholdremains140/90mmHg,withatreatmenttargetof<140/90mmHgforthosewhoarefunctionallyindependent,and<150/90mmHgforfrailolderadultswithlimitedlifeexpectancy.Theguidelinesalsoupdatetheriskstratificationsystemforpatientswithhypertension,nowincorporatingthreenewriskfactors:elevatedfastingbloodglucose(5.6to6.9mmol/L),elevatedhomocysteinelevels(≥15μmol/L),andafamilyhistoryofprematurecardiovasculardisease(first-degreerelativeswithcardiovasculardiseasebeforeage55inmenor65inwomen).ThesefactorswereaddedbasedondatafromChinesecohortstudiesshowingthattheyareindependentpredictorsofcardiovasculareventsinhypertensivepatientsinChina.Intermsofpharmacologicaltreatment,theguidelinesrecommendfourfirst-lineantihypertensivedrugclasses:calciumchannelblockers(CCBs),angiotensin-convertingenzymeinhibitors(ACEIs),angiotensinIIreceptorblockers(ARBs),andthiazide-likediuretics.Akeyupdateistherecommendationforinitialcombinationtherapyinpatientswithbloodpressure≥140/90mmHg(or≥135/85mmHginhigh-riskpatients),ratherthanstepwisemonotherapy.Fixed-dosecombinationpillsarepreferredoverfreecombinationtherapytoimprovetreatmentadherence.TheguidelinesalsoexplicitlyrecommendthatCCBsarethepreferredfirst-lineagentforelderlyhypertensivepatientsinChina,basedonevidencethatCCBshavebetterefficacyinreducingstrokeriskinEastAsianpopulationscomparedwithotherdrugclasses.Forpatientswithhypertensionandcomorbidities,theguidelinesprovidespecifictreatmentrecommendations:forhypertensivepatientswithtype2diabetes,thetreatmenttargetis<130/80mmHg,andACEIsorARBsarepreferredasfirst-linetherapyduetotheirrenalprotectiveeffects;forhypertensivepatientswithcoronaryheartdisease,beta-blockersarerecommendedasfirst-linetherapyinadditiontoACEIs/ARBstoreducetheriskofmyocardialinfarctionandsuddencardiacdeath;forhypertensivepatientswithchronickidneydisease(CKD)withproteinuria,ACEIsorARBsarefirst-lineagents,withatreatmenttargetof<130/80mmHg.Theguidelinesalsoemphasizetheimportanceoflifestylemodificationasthefoundationofhypertensionmanagement,includingreducedsodiumintake(target<5g/day),increasedpotassiumintake,regularphysicalactivity,weightmanagement,smokingcessation,andlimitedalcoholconsumption.Specialattentionispaidtothehighprevalenceofhigh-sodiumdietsinChina,withaspecificrecommendationforpopulation-widesodiumreductionprogramstoreducetheoverallburdenofhypertension.36.Whatisthediagnosticthresholdforhypertensionin45-year-oldadultsaccordingtothe2024guidelines?A.130/80mmHgB.135/85mmHgC.140/90mmHgD.145/90mmHg37.WhichofthefollowingisNOTanewriskfactoraddedtothe2024guidelines’riskstratificationsystem?A.ElevatedfastingbloodglucoseB.ElevatedhomocysteinelevelsC.FamilyhistoryofprematurecardiovasculardiseaseD.Chronickidneydiseasewithproteinuria38.Accordingtothe2024guidelines,whatistherecommendedinitialtreatmentfora50-year-oldpatientwithabloodpressureof145/92mmHgandnoothercomorbidities?A.Lifestylemodificationonly,withfollow-upin3monthsB.Monotherapywithathiazide-likediureticC.Initialcombinationtherapywithtwofirst-lineagentsD.Monotherapywithabeta-blocker39.WhyareCCBsrecommendedasthepreferredfirst-lineagentforelderlyhypertensivepatientsinChina?A.TheyhavefewersideeffectsthanotherantihypertensiveagentsB.TheyaremoreeffectiveinreducingstrokeriskinEastAsianpopulationsC.TheyarelessexpensivethanotherdrugclassesD.Theyprovidebetterrenalprotectioninelderlypatients40.Whatisthetreatmenttargetforhypertensivepatientswithtype2diabetesaccordingtothe2024guidelines?A.<130/80mmHgB.<135/85mmHgC.<140/90mmHgD.<145/90mmHgPartⅢCloze(20items,0.5pointeach,total10points)Directions:Thereare20blanksinthefollowingpassage.ForeachblanktherearefourchoicesmarkedA,B,CandD.YoushouldchoosetheONEthatbestfitsintothepassage.Postoperativedeliriumisacommonandseriouscomplicationinelderlypatientsundergoingsurgery,characterizedbyacutechangesinconsciousness,attention,andcognitionthatfluctuateoverashortperiodoftime.Itaffects10%to50%ofelderlypatientsundergoingmajorsurgery,andisassociatedwith_41_outcomesincludingprolongedhospitalstay,increasedriskofpostoperativecomplications,long-termcognitivedecline,andhighermortality.Understandingtheriskfactorsandimplementing_42_strategiesiscriticaltoreducingtheburdenofthiscondition.Theriskfactorsforpostoperativedeliriumcanbe_43_intopredisposingfactorsandprecipitatingfactors.Predisposingfactorsarepre-existingcharacteristicsthatincreaseapatient’svulnerabilitytodelirium.Themostsignificantpredisposingfactoris_44_age,withpatientsaged75yearsandolderhavinga3to5timeshigherriskthanthoseaged65to74years.Otherpredisposingfactorsincludepre-existingcognitiveimpairmentordementia,historyofdelirium,_45_alcoholuse,chronickidneydisease,andfunctionaldependenceinactivitiesofdailyliving.Precipitatingfactorsareeventsorexposuresduringtheperioperativeperiodthattriggerdeliriuminvulnerablepatients.Commonprecipitatingfactorsincludepostoperativepain,_46_ofsleep,useofcertainmedications(particularlybenzodiazepines,anticholinergics,andopioidanalgesics),electrolyteimbalances,hypoxia,infections,andsuddenchangesinenvironment._47_,surgicalfactorssuchasthetypeofsurgery(withthoracic,cardiac,andorthopedicsurgerieshavingthehighestrisk),durationofsurgery,andneedforintraoperativebloodtransfusionalsoplayarole.Thediagnosisofpostoperativedeliriumisprimarily_48_onclinicalassessment,astherearenospecificlaboratoryorimagingteststhatcanconfirmthecondition.TheConfusionAssessmentMethod(CAM)isthemostwidelyused_49_toolfordelirium,withasensitivityof94%to100%andaspecificityof