2020年医学博士外语真题试卷

Scientists have long known a fairly reliable way to extend the life span in lab animals. reduce the a-mount of calories they eat by 10 to 40 percent.

This strategy, known【C1】_____calorie restriction, has been shown to increase the life span of various organisms and reduce their rate of cancer and other age-related ailments.【C2】__it can do the same in people has been an open question. But an intriguing new study suggests that in young and middle-aged adults, chronically restricting calorie【C3】_____can affect their health.

In this study, researchers looked at 143 healthy men and women who【C4】________in age from 21 to 50.

They were instructed to【C5】_____calorie restriction for two years. They could eat the foods they wanted【C6】__they cut back on the total amount of food that they ate to reduce the calories they consumed by 25 percent. Many did not 【C7】_____ that goal. But the group saw many of their metabolic health markers improve【C8】________they were already in the normal range.

Some of the benefits in the calorie-restricted group【C9】_____from impressive weight loss, on average a-bout 16 pounds during the study period. But the extent to which their metabolic health got better was greater than expected from weight loss alone, 【C10】_____that calorie restriction might have some unique biological effects on disease pathways.

Gianluca Vialli, manager of Chelsea Football Club, expressed it explicitly enough: “The foot is the tool of the trade of the footballer. “You might therefore expect footballers to take particularly good care of their feet. But results presented at a recent conference of dermatologists in Amsterdam suggest otherwise. Professional footballers seem as likely to suffer from fungal infections of the foot as other people.

One study, calledAchilles Project, looked at 76, 475 pairs of feet belonging to people from 18 European countries. It found that 26% of the sample had Tinea pedis, better known as athlete’s foot, while 30% had Onychomycosis, an infection that causes toenails to become thickened, discolored and distorted. The results showed that East European countries have consistently higher rates of infection. On average, 30% of Britons, Germans and Belgians had some form of fungal infection, compared with 85%of Russians, and less than 10% of Spaniards.

Furthermore, adults under the age of 40 who took regular exercise had a 40% greater risk of fungal infection than those who did not. Leisure centers and swimming pools were identified as potential health hazards to the very people who visit them to stay fit. Communal showers and changing rooms are perfect breeding-grounds for the highly infectious fungi that spread foot and nail infection: up to 1, 500 fungally-infected skin fragments per square meters have been found in some leisure facilities. Sweaty socks and warm, damp sports shoes provide equally hospitable environments.

All of which goes some way to explaining the footballers. No doubt all that time spent in showers and changing-rooms is partly responsible. But Dr. Caputo, a dermatologist, also found another factor: foot-ballers are often reluctant, for superstitious reasons, to discard their old boots. He found that players get attached to particular boots; if they score a goal with one, they will wear it again and again. The risk of athlete’s foot may be a small price to pay for a goal.

A decade ago, most patients were informed over the phone or in person by the doctors. But in the past few years, hospitals and medical practices have urged patients to sign up for portals, which allow them rapid, round-the-clock access to their records. Lab tests are now released directly to patients.

The push for portals has been fueled by several factors: the widespread embrace of technology, incentive payments to medical practices and hospitals that were part of 2009 federal legislation to encourage “meaningful use”of electronic records, and a 2014 federal rule giving patients direct access to their results. Policymakers have long regarded electronic medical records as a way to foster patient engagement and improve patient safety.

Are portals delivering on their promise to engage patients’? Or are these results too often a source of confusion and alarm for patients and the cause of more work for doctors because information is provided without adequate—or sometimes any—guidance?

Although what patients see online and how quickly they see it differs—sometimes even within the same hospital system—most portals contain lab tests, imaging studies, pathology reports and less frequently, doctors’ notes. It is not uncommon for a test result to be posted before the doctor has seen it.

Katharine Tread way, an internist, knows what it’s like to obtain shocking news from an electronic medical record. The experience, she said, has influenced the way she practices. More than a decade ago—long before most patients had portals—Treadway, with her husband’s permission, pulled up the results of his MRI scan on a hospital computer while waiting to see the specialist treating his sudden, unbearable arm pain.

“It showed a massive tumor and widespread metastatic disease, “Treadway recalled. She never suspected that her 59-year-old husband had cancer, let alone a highly aggressive and usually fatal form of advanced lymphoma.

Treadway, whose husband has been cancer-free for more than a decade, said she remembered intently checking the name and date of birth, certain she had the wrong patient, then rebooting the computer several times “like I was going to get a different answer.”

In planning for the health needs of these immigrant families, Francesca Weissman, a healthcare practitioner, asked two questions: “What are the most urgent needs of this population?” and “How can this population be induced to use the health services that are available?” In some respects, the second question is more important because persuading immigrant families to utilize services is a basic problem.

Building trust is a primary goal. Employing caregivers who can speak the clients’ language will do much to lower ethnic barriers and reduce suspicion on the part of the potential clients. Many traditional families are slow to develop personal relationships, and this holds true in the interactions with caregivers. Unless the families can communicate with caregivers, they cannot begin to trust them. Without trust, they are not likely to seek or even accept assistance.

Communication is a two-way channel. Caregivers, Francesca realized, have an obligation to become acquainted with the culture of the growing ethnic populations, and of their diverse subgroups. By becoming informed and by conveying respect, caregivers can make interactions with immigrant families less frightening and more productive. Awareness of the economic climate and other conditions in the place of origin helps caregivers recognize that the suspiciousness of immigrant families towards officials may not be wholly irrational.

A family approach to health care is recommended for immigrant groups. If the whole family can be in-volved in the healthcare program, the individual members are likely to be less fearful. Family-oriented pro-grams may begin with practical advice about the neighborhood: locations of grocery stores, where to ap-ply for food stamps, and how to look for work. Any programs developed for immigrant families must be offered at convenient times and places because they may not have the knowledge or resources to travel freely in their new community.

This year mark the 100th anniversary of the deadliest event in U. S. history: the Spanish influenza epi-demic of 1918. Although science and technology have advanced tremendously over the past century, the pandemic peril remains; a recent exercise at the Johns Hopkins Center for Health Security showed that an epidemic of an influenza—like virus could kill 15 million Americans in a single year.

The medical community’s response to this danger is, understandably, focused on research and response—discovering new vaccines, therapeutics, and diagnostics and fighting ongoing epidemics, such as the current Ebola outbreak in Congo. But these urgent undertakings are not sufficient. If the World is to tack-le many factors that raise our risk of a devastating pandemic, the medical community may have to enter the atres of operation beyond the laboratory bench and the treatment unit and publicly engage with controversial issues that some observers would consider nonmedical. Indeed, I believe that only such efforts can save us from the social trends, political movements, and policy failures that are elevating our risk of a pandemic. There are three aspects in particular where the medical community’s intervention is urgently needed.

First is the rising tide of isolationism and xenophobia (排外) in many high-income nations, particularly the United States and European countries. The belief that isolating ourselves from the world can prevent the spread of diseases is irrational: we can build no wall high enough to keep out infectious diseases and disease-bearing vectors.

The second trend is the growing tide of antiscientific thinking and resistance to evidence-based medicine. In low-income countries, skepticism about vaccines is an everlasting challenge, but what we are seeing in the United States and Europe is something very different, and very dangerous. The growing refusal of parents in high-income countries to vaccinate their children is the tip of an iceberg that could sink us all in the event of an epidemic demanding rapid vaccine deployment and acceptance.

Finally, and perhaps most fundamentally, medical professionals can step into the public arena to take on unpleasant and contentious political issues such as climate change and isolationism. Many members of the medical community prefer to avoid becoming involved in controversial issues that seem to be outside the scope of medical concerns, but their voices are needed to confront such issues.

In medical terminology,the words history and physical almost always appear together in that order. As a physician, you do not engage a patient in the neurological examination until you’ve gathered the de-tails of his or her debilitating headaches.

But at one time in our medical careers, we are instructed to perform the most thorough physical examination possible without learning so much as the patient’s name. All we are given is an anatomy table number, an age, and a cause of death. We work our way through the anatomy lab—inspecting, searching, and feeling every muscle, bone, and organ—and we write our patients’ histories ourselves.

To better understand the life of the woman who had donated her body for my education, I created the Obituary (讣告) Writing Program at Georgetown University during my first year of medical school. I worked with an obituary writer, Emily Langer, to develop a workshop to help interested medical students reflect on the lives that their corpses may have lived. She instructed us on the art of weaving disconnected memories into a single story. A series of creative writing prompts resulted in one student’s story of a dramatic foot-ball injury occurring in the middle of a competitive match. This moment in his corpse’s life was imagined from a pink prosthetic (假体的) hip beneath massive layers of muscle.

The first conversation with my donor’s son lasted over an hour despite my initial fear that I would ask the wrong questions or offer the wrong words of sympathy. His mother was a small-town farm girl from Wisconsin, Dr. Carol Kennedy, Georgetown University School of Medicine, Class of 1972. She was a devout Catholic who considered being a physician a privilege and an opportunity to serve others. She wanted to continue to serve even after her death by donating her body to Georgetown University in order to educate future medical students like me.

We have finally put the history in its rightful place before the physical—students now interview the families of their donors before making the first cut in the anatomy lab. Our corpses are our first counterparts in the privileged patient-physician relationship, and now we are able to begin that partnership just as we hope to do throughout the rest of our medical careers.

There may be no better example of what is meant by preventive medicine than the strategy of Vaccination. A healthy person is given a tiny taste of a virus—flu or polio, say—that’s too weak to cause illness but just enough to introduce the body to the pathogen. If the virus later shows up for real, the immune system is primed and waiting for it.

That’s close to how a cancer vaccine works, but not precisely. Most experts see cancer vaccines as a hybrid of treatment and prevention. While it’s true that the U. S. Food and Drug Administration has ap-proved vaccines against cervical and liver cancer, both are designed to fight the viruses most responsible for causing the disease, as opposed to targeting cancer itself—human papilloma virus (HPV:人乳头瘤病毒) in the case of cervical cancer and hepatitis B in the case of liver tumors.

Using vaccines to prevent nonviral cancers in someone who is disease-free is a whole different matter. For one thing, it’s much more difficult to determine a person’s chance of developing a particular type of cancer than it is to determine the likelihood of being exposed to, say, the influenza virus or chicken pox. Whatpasses for “exposure”in the case of nonviral cancers is a combination of genes and environment and a range of other X factors that can vary from person to person. How do you vaccinate against your family legacy of breast cancer or your constant exposure to secondhand cigarette smoke?

But that doesn’t mean the immune system can’t be exploited in a different way. Cancer vaccines would ideally be used in patients whose disease has already been diagnosed and treated with surgery, chemotherapy or radiation. They would then be immunized as a way to prevent the cancer from coming back and spreading. Such metastases are actually the leading cause of death from cancer. “The charm of working with the immune system is that we can use the body’s own defense mechanisms to possibly get to that last cancer cell or at least create a surveillance system that keeps that cancer under control,” says an oncologist.