2022年医学博士外语真题试卷

This year the world awakened to the fact that the most powerful and sophisticated species on earth is tragically【C1】_____to the tiniest and most basic of creatures. Infectious disease specialists【C2】_____about this for decades.

And the threat comes not only from novel viruses, 【C3】_____the one causing COVID-19, that jump from animals to humans but also from microbial monsters that we have helped to create through our【C4】__use of antibiotics：treatment-resistant bacteria such as MRSA (miethicillin-resistant Staphylococcus aureus) and multidrug-resistant Acinetobacter baumannii, sometimes dubbed “Iraqibacter”because so many soldiers returning from Iraq were infected with it. The World Health Organization has【C5】_____that deaths from resistant “superbugs”will rise from roughly 700,000 a year today to nearly 10 million by 2050.

But in a splendid irony, it may turn out that viruses, so often seen as nemeses, 【C6】________be our saviors in fighting a host of killer infections.

【C7】_____the threat from drug-resistant bacteria has grown and the development or new antibiotics has stalled, researchers have turned their attention to bacteriophages — 【C8】_____, bacteria eaters.

Viruses in this【C9】_____are believed to be the oldest and most numerous organisms on earth. And like guided missiles, each type has【C10】_____to seek and destroy a specific type of bacteria. Phage therapy has long been used in eastern Europe to battle infections, but after modern antibiotics arrived in the 1940s, it was largely ignored. Interest began to pick up in this century “because the resistance issue was getting worse and worse, “says Vincent Fischetti, who heads the laboratory of bacterial pathogenesis and immunology at the Rockefeller University. With modern techniques, virologists can precisely match just the right phages to a specific strain of superbug—with sometimes astonishing results.

People often discuss the dangers of too much stress, but lately a very different view of stress is gaining popularity. this view of stress, held by members of the positive stress movement, argues that stress might actually be beneficial. The positive stress movement is made up of people such as Zachary Rapp who are looking for an edge in a competitive world, and Rapp’s routine is a good example of followers of the movement. He wakes up most mornings at dawn, goes for a run, sips black coffee while rippling through emails, and then steps into freezing cold shower. This is a routine designed to reduce the stress of running simultaneously three different health and biotechnology companies for 18 hours a day.

Although Rapp’s practices may sound extreme, he is part of a growing movement, consisting largely of tech industry workers who claim that such radical tactics will help them live better and longer. Inspired by influential figures in different fields, including entertainers, athletes, entrepreneurs and scientists, positive stress practitioners seek out some combination of extreme temperatures, restrictive diets, punishing exercise routines and general discomfort.

Rapp argues that positive stress keeps him balanced. In addition to running and freezing showers, Rapp uses ice baths, hot yoga, and unconventional eating practices such as eliminating dairy, sugar, alcohol and various other foods high in carbohydrates. He believes that these practices, which put stress on his body, actually make him feel less stress from work. However, Rapp does not credit anyone in particular for his choices: he said he started using these methods in college, where he got into the habit of taking ice baths to recover from sports. He got back into it while trying to get his three companies off the ground.

Rapp works long hours and sleeps only five to seven hours a night but he said he only gets sick once a year. For him, the difference between day-to-day stress, like the kind we feel when moving apartments, and positive stress is that the latter involves pushing the body to extremes and forcing it to build up a tolerance.

But it is important to note that not everyone agrees with these practitioners; indeed, some medical professionals argue that positive stress is not for everyone, and that it might even be dangerous for people who are unhealthy or older.

Early diagnosis has become one of the most fundamental precepts of modern medicine. It is thought to be the best way to keep people healthy: to find out if they have (pick one) heart disease, autism, diabetes, vascular problems, osteoporosis or, of course, cancer—early.

Recently, however, there have been rumblings within the medical profession that suggest that the enthusiasm for early diagnosis may be waning. Most prominent are recommendations against prostate cancer screening for healthy men and for reducing the frequency of breast and cervical cancer screening. Some experts even cautioned against the recent colonoscopy results, pointing out that the study participants were probably much healthier than the general population, which would make them less likely to die of colon cancer.

The basic strategy behind early diagnosis is to encourage the well to get examined—to determine if they are not, in fact, sick. But is looking hard for things to be wrong a good way to promote health? The truth is, the fastest way to get heart disease, autism, diabetes, vascular problems, osteoporosis or cancer… is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.

Screening the apparently healthy potentially saves a few lives. But it definitely drags many others into the system needlessly—into needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms). This process doesn’t promote health; it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember. these people felt fine when they entered the health care system.

Increasingly we operate under the early diagnosis precept: seeking diagnosis and initiating therapy in people who are not experiencing problems. That’s ahuge change in approach, from one that focused on the sick to one that focuses on the well. Some doctors have long recognized that the approach is a distraction for the medical community. It’s easier to transform people into new patients than it is to treat the truly sick. It’s easier to develop new ways of testing than it is to develop better treatments. And it’s a lot easier to measure how many healthy people get tested than it is to determine how well doctors manage the chronically ill.

The rumblings show that that’s beginning to change. Let me be clear: early diagnosis is not always wrong. The question is how often and how far we should get ahead of symptoms.

For years now, people have been encouraged to look to medical care as the way to make them healthy. But that’s your job—you can’t contract that out. Doctors might be able to help, but so might an author of a good cookbook, a personal trainer, a cleric or a good friend. We would all be better off if the medical system got a little closer to its original mission of helping sick patients, and let the healthy be.

It was a big week for Alzheimer’s disease, and not just because PBS aired The Forgetting, a first-rate documentary about Alzheimer’s worth catching in reruns if you missed it the first time. There was also a flurry of scientific news that offered hope to the families already struggling with Alzheimer’s, as well as to the baby-boom generation that’s up next. Unless something dramatic happens, the number of Americans living with this terrifying brain disease could triple, to about 16 million, over the next 50 years. There’s still no cure in sight, but there is progress on several fronts. Among them:

MEGADOSE VITAMINS. Doctors knew vitamins E and C, both antioxidants, helpstave offAlzheimer’s, at least in folks who haven’t already developed the disorder. What they didn’t know —but a big study in-volving 4, 740 participants published in the Archives of Neurology showed—was that the two vitamins taken together in huge daily doses (at least 400 IU of E and more than 500 mg of C) could reduce the risk of Alzheimer’s a remarkable 78%.

COMBINATION THERAPY. A yearlong study of more than 400 Alzheimer’s patients showed that two drugs that work differently on the brain’s chemistry act well together to help slow down the disease. Patients who were being treated with donepezil (sold as Aricept), an older drug that preserves the neuro-transmitter acetylcholine, were also given memantine (Namenda), a new drug approved by the FDA last October that blocks overproduction of a harmful brain chemical called glutamate. The two drugs worked even better in combination than they did alone, providing substantial benefit for patients with moderate to severe Alzheimer’s, according to a report in the Journal of the American Medical Association.

BRAIN IMAGING. Finally, scientists at the University of Pittsburgh announced that they had success-fully developed a procedure that allows them to peer into the brains of Alzheimer’s patients with positron emission tomography (PET) scans to see telltale plaque deposits. Before now, doctors could not track the progress of these plaques until after the patient died, when the brain could be autopsied. Using the new technique, doctors may be able to begin treatment long before the first symptoms appear.

None of these advances is a magic bullet for Alzheimer’s disease. If you or your loved ones are concerned, the first step is careful evaluation by your doctor. Not all memory lapses are Alzheimer’s, and there are reversible causes of forgetfulness that can be treated if caught early. Also, remember the old ad-age “use it or lose it”. Mental exercise—reading, doing crossword puzzles, playing chess or Scrabble— is as good for preserving your mind as physical exercise is for your body.

Over the last 20 years, international organizations spearheaded by GAVI, the Vaccine Alliance—in partnership with national governments, the World Health Organization and UNICEF—have ensured that significantly more children in poor countries in Africa and elsewhere get routine vaccinations. 81 per cent to-day versus 59 per cent in 2000. And that has had a major impact—a 70 per cent drop in child mortality from vaccine-preventable diseases over two decades.

But what about the root causes of non-vaccination of the young：is the problem one of poverty alone, of the failure of domestic governments and their public-health departments to reach the most vulnerable communities, or simply of an inability to overcome deep-rooted social disadvantages? A new Canada-India study of tens of thousands of zero-dose children in India suggests that the cause of low-vaccination rates in lower-income countries is all of those and more.

The study analyses a quarter century of national survey data to better understand how social, economic and geographical inequalities in India shaped the chances of children remaining unvaccinated between 1992 and 2016. They found that India had made tremendous progress in reaching children with routine immunisation. But they also found that, in 2016, children remained concentrated among disadvantaged groups, including the lowest-income households and children born to mothers who had no formal education.

As well, compared with vaccinated children, zero-dose children were more likely to suffer from malnutrition. For instance, in 1992, 41 percent of zero-dose kids had severely stunted growth; by 2016, the numbers had declined but were still disproportionate. “Over a 24-year period in India, child zero-dose status was shaped by large-scale social inequalities and remained a consistent marker of generalised vulnerability, “the researchers concluded. “Interventions that address this cycle of intergenerational inequities should be prioritised. “

Professor Johri pointed to the uniqueness of the work of her and her colleagues. “It’s the first to trace aggregate patterns in zero-dose children over time globally and in India, “said Johri, who is an overseas citizen of India as well as a Canadian citizen.

More globally, the Indian experience suggests that “child zero-dose vaccination status is an important marker of vulnerability linked to systematic disadvantage over the life course, “Johri said. “Identifying zero-dose children and intervening early to address the complex sources of disadvantage they face has the potential to transform life opportunities and combat intergenerational inequities. It should be a top priority for the international community.”

Sound meditation is a form of focused awareness type of meditation. One kind that has become more popular is called “sound baths”, which uses Tibetan singing bowls, quartz bowls, and bells to guide the listener. These practices highlight themes of how the experience of sound manifests not only through hearing but through tactile physical vibrations and frequencies. Science is still catching up to understanding how sound heals, but the current research is promising. A review of 400 published scientific articles on mu-sic as medicine found evidence that music has mental and physical health benefits. In fact, rhythm in particular can provide physical pain relief. One study published in the Journal of Evidence-Based Integrative Medicine found that an hourlong sound meditation helped people reduce tension, anger, fatigue, anxiety, and depression while increasing a sense of spiritual well-being.

There are many different theories that attempt to explain why sound experiences can be linked with deep relaxation and physical pain relief. One theory is that sound works through the vibrational tactile effects on the whole body. Sound could stimulate touch fibers that affect pain perception. One study of people with fibromyalgia found that ten treatments (twice per week for five weeks) of low-frequency sound stimulation improved sleep and decreased pain, allowing nearly three-fourths of participants to reduce pain medication. Sound-based vibration treatment has been shown to help people with pain from arthritis, menstrual pain, postoperative pain, knee replacement pain. Another theory on the benefits of sound rests on the concept of “binaural beats” which hypothesizes that listening to certain frequencies can synchronize and change one’s brainwaves.

Different states of alertness and consciousness in different parts of the brain generate varying frequencies of brainwaves. Beta waves are the fastest type of brainwave and occur when the brain is active and engaged mentally. Alpha waves occur when the brain is in a state of non-arousal, such as when a person has finished a task and is resting. Theta brainwaves are associated with daydreaming and rapid eye movement (REM) dreaming phase of sleep. Theta brainwaves occur when you are in a state like driving on the freeway or are running for a long time. Delta brainwaves are the slowest and associated with deep dream-less sleep.

The premise of binaural beats is that the brain synchronizes its brainwave frequency to the difference in hertz between tones played in each ear, which, depending on the frequency, can lead one to states of deep relaxation associated with beta waves or meditative trance-like theta waves. Researchers are still trying to determine the mechanism of the healing benefits of sound, but sound in the form of vibrational therapy or meditation offers potential therapeutic benefits with low to minimal side effects.

With the rapid development of network connection, the popularity of smart phones and the constant changes of insurance standards, more and more medical service providers begin to use electronic communication equipment to complete their work. More than 15 million Americans received some form of tele-medicine last year, according to the American Telemedicine Association. The group predicts that the number will increase by 30% next year. In the past year, the number of patients, medical organizations and employers using telemedicine services in the United States has increased.

Through telephone, video and email, customers can establish contact with doctors they have never met. Usually, these customers are consulting about less serious diseases, such as colds, flu, ear pain and rashes, which cost about $45 each time. In the same way, it costs $100 to go to the doctor’s office, $160 to the emergency clinic, and $750 to the emergency room. Many health care plans and employers can’t wait to provide these services to their members, so that they can get convenient medical services without having to go out of the house. This year, nearly 75% of employers in large companies will provide telemedicine services to their employees as a benefit. The number is 48% higher than last year.

But the above data does not show that telemedicine has entered every household. Recently, Health-mine conducted a survey of 500 tech savvy consumers and found that 39% still don’t know what telemedicine is. Of these people, 42% tend to communicate with doctors face to face. In another survey of 1, 500 family doctors, only 15% had ever used telemedicine at work. In the case of rapid growth, telemedicine industry still has significant problems and challenges.

The American Medical Association (AMA) approved a new code of ethics for telemedicine this month, calling on telemedicine practitioners to recognize the limitations of the service and to make medical recommendations when they have enough information about patients.

However, there is not always a consensus on the limitations of telemedicine examination. Jason Gorevic, CEO of teladoc, which went public last year, said his group has designed more than 100 treatment guidelines based on the characteristics of telemedicine, including a five point scale to guide doctors’ tele-medicine behavior. Even so, the Centers for Disease Control and Prevention recommends that doctors take a quick test or throat test before prescribing antibiotics.

Employers and Medicare programs are willing to pay for telemedicine, but insurers are less happy with the way patients call, email or video to consult doctors about long-standing health problems. Unless you go to the scene to consult a doctor, it’s very difficult to cover the cost of seeing a doctor.

More and more hospitals will tend to invest in telemedicine systems, and other academic centers have also started to provide remote counseling services.