蘇州市人民醫(yī)院消化內(nèi)科「英語查房」能力考核標準一、選擇題（共10題，每題2分，合計20分）說明：以下題目基于蘇州市人民醫(yī)院消化內(nèi)科常見疾病及診療流程設(shè)計，考察考生在英語查房中的專業(yè)表達與臨床判斷能力。1.Whenassessingapatientwithchronicgastritis,whichsymptomismostindicativeofatrophicchanges?A.EpigastricpainrelievedbyantacidsB.MelenawithoutobviousupperGIbleedingC.AnemiawithelevatedpepsinogenI/IIratioD.Frequentbelchingaftermeals答案：C解析：AtrophicgastritisoftenleadstodecreasedgastricacidproductionandanemiaduetovitaminB12malabsorption,whichcanbereflectedbyanelevatedpepsinogenI/IIratio(lowPGI/PGII).Otheroptionsarelessspecificforatrophy.2.A65-year-oldmalewithdysphagiafor2monthspresentswitha"ringing"sensation.Whichdiagnostictestshouldbeprioritized?A.EsophagealmanometryB.BariumesophagogramC.Esophagealultrasound(EUS)withfine-needleaspirationD.ChestCTwithcontrast答案：C解析：The"ringing"sensationsuggestsasubmucosallesion(e.g.,leiomyomaorschwannoma),whichEUSwithFNAisbestfordiagnosis.Manometryandbariumstudiesarelesssensitiveforsubmucosaltumors.3.WhichlaboratoryfindingstronglysupportsthediagnosisofHelicobacterpyloriinfectioninapatientwithduodenalulcer?A.ElevatedC-reactiveprotein(CRP)B.Positiverapidureasetest(C13orC14)C.HighfecalcalprotectinD.DecreasedserumpepsinogenII答案：B解析：TherapidureasetestisthegoldstandardforH.pyloridetectioninendoscopy.CRPreflectsinflammationbutisnon-specific;fecalcalprotectinisforIBD;pepsinogenIIdecreasesinatrophicgastritis.4.Apatientwithsuspectedesophagealvaricealbleedingshouldbeadministeredwhichmedicationimmediately?A.OctreotideB.PantoprazoleC.CeftriaxoneD.Terlipressin答案：A解析：Octreotideandterlipressinarefirst-linevasoconstrictorsforacutevaricealbleeding.Protonpumpinhibitors(PPIs)likepantoprazoleareadjunctivebutnotprimarytreatments.5.Whichsignduringendoscopysuggestsamalignantgastrictumor?A.Non-tenderepigastricmassB.ExophyticpolypwithvisiblevesselsC.UlcerwithirregularmarginsandbleedingoncontactD.Flatmucosallesionwitherosion答案：C解析：Malignantulcersarecharacterizedbyirregularborders,induration,andactivebleeding,unlikebenignulcerswithsmoothedges.Exophyticpolypsareusuallybenign.6.A50-year-oldfemalewithnew-onsetdiarrheaandweightlossshouldbetestedforwhichinfection?A.GiardialambliaB.CryptosporidiumC.EntamoebahistolyticaD.Norovirus答案：A解析：Giardiaisacommoncauseofchronicdiarrheapost-infectiousgastroenteritis,especiallyinadults.Cryptosporidiumismorecommoninimmunocompromisedindividuals.7.Whichmedicationiscontraindicatedinapatientwithacutepancreatitisduetoalcoholabuse?A.UrsodeoxycholicacidB.PantoprazoleC.OctreotideD.Gabapentin答案：A解析：Ursodeoxycholicacidisusedforchronicpancreatitisbutcanworsenacutepancreatitisbystimulatingbiliarysecretion.PPIs,octreotide,andgabapentinaresupportive.8.ApatientwithCrohn’sdiseasepresentswithperianalfistula.Whichtestismostusefulforassessingdiseaseextent?A.ColonoscopywithbiopsiesB.MRIenterographyC.CTenterographyD.Smallbowelseries答案：B解析：MRIenterographyissuperiorforevaluatingperianaldiseaseandsmallbowelinvolvementinCrohn’s.Colonoscopyislimitedtothecolon.9.Whichclinicalscenariowarrantsurgentendoscopichemostasisforvaricealbleeding?A.Bloodtransfusionrequirement>2units/hourB.Plateletcount<50,000/μLC.PresenceofactiveoozingfromvaricesD.Biliousvomiting答案：C解析：Activeoozingindicatesongoingbleedingandrequiresimmediateendoscopy.Transfusionrate,platelets,andbiliousvomitingaresupportivebutnotabsoluteindications.10.Apatientwithnon-steroidalanti-inflammatorydrug(NSAID)-inducedgastritisshouldavoidwhichfooditem?A.GarlicB.CoffeeC.TomatoproductsD.Ginger答案：C解析：Tomatoproductscontainsolanine,whichmayexacerbategastricinflammationinNSAIDusers.Garlic,coffee,andgingerhavevariableeffectsbutarelessproblematic.二、簡答題（共5題，每題4分，合計20分）說明：考察考生對消化系統(tǒng)疾病英文查房中關(guān)鍵問題的表述能力。1.ExplaintherationaleforperforminganEUSinapatientwithunexplainedascites.答案：EUSisusedtoruleoutmalignancy(e.g.,peritonealcarcinomatosis)orpseudomalignancy(e.g.,lymphoma)inascitesofunclearetiology.Itcanalsoidentifyprimaryperitonealtumorsorceliacdiseasemimickingascites.2.DescribethetypicalfindingsofBarrett’sesophagusonendoscopy.答案：Barrett’sesophaguspresentsassalmon-pinkorreddishcolumnarepitheliuminthedistalesophagus,oftenwithverticalfolds.Itmayprogresstodysplasiaandadenocarcinoma.3.OutlinethestepsformanagingapatientwithacuteupperGIbleeding.答案：-Stabilizehemodynamics(IVfluids,bloodtransfusionifneeded).-Performendoscopytoidentifysourceandtreatbleeding(e.g.,clips,epinephrine).-AdministerPPIsandvasoconstrictors(octreotide/terlipressin).-Monitorlabs(Hb,coagulation)andavoidnon-NSAIDs.4.Whyisthefecalimmunochemicaltest(FIT)preferredovertheguaiactestforcolorectalcancerscreening?答案：FITdetectsoccultbloodwithhigherspecificity(nofalsepositivesfromNSAIDs,iron,orhemorrhoids),highersensitivityforsmallorintermittentbleeding,andeasierpatientadherence.5.ExplainthedifferencebetweenHelicobacterpylorigastritisandautoimmunegastritis.答案：-H.pylorigastritis:Inflammationlimitedtoantrum(gastritis)orcorpus(pangastritis),withelevatedpepsinogenII.-Autoimmunegastritis:Diffusecorpusatrophy,absentparietalcells(perniciousanemia),lowpepsinogenI,andelevatedanti-parietalcellantibodies.三、病例分析題（共3題，每題10分，合計30分）說明：結(jié)合真實病例情境，考察考生英文查房中的綜合分析能力。Case1:A72-year-oldmalewitha1-weekhistoryofworseningabdominalpainandjaundice.Labsshowbilirubin12.5mg/dL,AST120U/L,ALT200U/L,andINR1.5.Viralhepatitisserologiesarenegative.Questions:1.Whatisthemostlikelydiagnosis?答案：Acutecholangitisorcholedocholithiasis(elevatedbilirubin/AST,jaundice,prolongedINRsuggestbiliaryobstruction).2.Whichimagingstudyshouldbeperformedfirst?答案：MRI/MRCPtoevaluatebileductswithoutcontrastrisk.3.Whatarethekeymanagementsteps?答案：-Startbroad-spectrumantibiotics(e.g.,ceftriaxone/aztreonam).-ERCPwithsphincterotomyifstonesareconfirmed.-Monitorvitalsignsandliverfunction.Case2:A55-year-oldfemalewithdiarrhea,weightloss,andarthralgiafor6months.Stoolstudiesshowpositiveanti-Saccharomycescerevisiaeantibodies(ASCA)andpancytopenia.Questions:1.Whatisthemostlikelydiagnosis?答案：Crohn’sdisease(ASCApositive,extraintestinalmanifestations).2.Whichtestisneededtoassessdiseaseextent?答案：CTenterographyorMRIenterographytoevaluatesmallbowelandcolon.3.Whatistheinitialtreatmentapproach?答案：-5-ASA(e.g.,mesalamine)formild-to-moderatedisease.-Biologics(e.g.,infliximab)ifsevereorsteroid-dependent.Case3:A68-year-oldmalewitha2-dayhistoryofepigastricpainaftertakingibuprofenforkneepain.Endoscopyshowsanon-bleeding,1-cmulcerinthegastricantrumwithmildedema.Questions:1.Whatisthemostappropriateinitialtreatment?答案：Pantoprazole40mgdailytoreduceacidsecretion.2.Whichfollow-upisrecommended?答案：Repeatendoscopyin4–6weekstoruleoutmalignancy.3.Whatlifestylemodificationsshouldbeadvised?答案：AvoidNSAIDs,takemedswithfood,andstopsmoking.四、填空題（共10題，每題1分，合計10分）說明：考察考生對消化系統(tǒng)疾病英文術(shù)語的掌握程度。1.The[]stageofesophagealsquamouscellcarcinomaislocalizedtothemucosa.答案：T12.[]isthefirst-lineagentforacutevaricealbleeding.答案：Octreotide3.The[]testdetectsoccultbloodinstoolviaantibodies.答案：Fecalimmunochemical4.[]gastritisiscausedbyautoimmunedestructionofparietalcells.答案：Autoimmune5.[]isacommonsymptomofgastroesophagealrefluxdisease(GERD).答案：Heartburn6.The[]scorepredictsriskofvaricealrebleeding.答案：Baveno7.[]isthegold