1、甲状腺疾病甲状腺疾病习题Translate and explanate：1.hyperthyroidism2.TSH receptor antibody3.hyperthyroidic heart disease4.subclinical hyperthyroidism5.apathetic hyperthyroidismQuestion and answer：1.Please explanate the three types of TSH receptor antibodies.2.Please state the three thyroid antibodies occuring in
2、Graves disease？3. Which of the two antibodies can be used as a sign of Graves ophthalmopathy activities? 4. what is the Induced factors of Thyrotoxic periodic paralysis ?5. what is characterized of Hematopoietic system when hyperthyroidism?6.Which causes can make thyroid-hormone binding immunoglobul
3、ins change？7. what is the most sensitive indicator to reflect Thyroid function?8. Which diseases were been found that the uptake rate of 131I increase or reduce (Give an example respectivly) ?9.What is the diagnosis stantard for hyperthyroidism？10. What are the adverse reactions of Antithyroid drugs
4、? 11.What is the mechanism of thyroid crisis？12. What are the main inducement of Hyperthyroidism crisis? Statements：1. what of clinical manifestations of Graves Simple ocular symptoms?2.Please state the peculiar clinical features and types of Graves disease？3.W hat is indications of Antithyroid drug
5、 treatment? 4.what are kinds and action mechanism of Antithyroid drug? Given two representatives of drugs respectivly5.What are the clinical features of thyroid crisis？6.Please state the salvage principle of thyroid crisis？单选题：1. TSH receptor is a kind of G-protein-coupled receptor family ,and compo
6、sed by _ amino acid . A.544 B.644 C.744 D.844 E.4442. The highest positive rate of antibody in patients with Graves A.TPOAb B.TgAb C . TRAb D.NIS E.TSBAb3. The antibody that could reflect the disease activity markers in blood circulation of patients with Graves ophthalmopathy A. D.针对眼外肌的抗体 B. TRAb C
7、. TPOAb D. TgAb 4. The most common disorders of the heart rate in patients with hyperthyroidism A.心房颤动 B.室性早博 C.房室传导阻滞 D.交界性早博 E.室速5. The age of morbidity of thyrotoxic periodic paralysis A.40-50岁 B.50-60岁 C.60-70岁 D.20-40岁 E.10-20岁6. Mild degree of hyperthyroidism exophthalmos in general does not e
8、xceed A.16mm B.18mm C.20mm D.22mm7. The sequence relations of occurrence of hyperthyroidism and Graves ophthalmopathy A.45%两者同时发生 B.43%两者同时发生 C.45%甲亢先于Graves眼病发生D.46%甲亢先于Graves眼病发生 E.47%甲亢先于Graves眼病发生8. Serum _is a reflection of the most sensitive indicator of thyroid function A. FT3 B.FT4 C.TSH D.
9、TRAb E. TgAb9. what is hyperthyroidism drug therapy adverse reactions? A.粒细胞减少 B.皮疹 C.中毒性肝炎 D.血管神经性水肿 E.急性关节炎10. The preferred choose drug is given during the full pregnancy A.丙基硫氧嘧啶 B.甲基硫氧嘧啶 C.他巴唑 D.甲亢平 E.心得安11. Thyrotoxic crisis is the most commonly found A. 甲亢口服药治疗时 B. 甲亢合并感染时 C. 妊娠期甲亢 D. 淡漠型甲亢 E
10、. 甲亢手术治疗后 12. the main clinical manifestations of thyrotoxic crisis :A. 呕吐、腹泻、脱水、休克、心慌气短 B. 心率加速、血压增高、脉压增大C 高热、脉率快、焦虑、大汗、呕吐、失水、休克 D.肺水肿、全身浮肿E 心慌、心率略快、血压下降、体温略高 多选题：1. The thyroid antibodies related with Graves disease A . TRAb B.TB C.TPOAb D.TgAb E.TSBAb2. The antibodies as a sign of disease activit
11、y in patients with Graves ophthalmopathy A. TPOAb B. TgAb C.针对眶后成纤维细胞的自身抗体 D.针对眼外肌的自身抗体 E. TRAb3. the performance of cardiovascular system when hyperthyroidism A.心悸气短 B.第一心音亢进 C.房颤多见 D.脉压差大 E.收缩压升高4. the performance of hematopoietic system when hyperthyroidism A.淋巴细胞比例增加 B.单核细胞增加 C.白细胞总数减低 D.可伴发血小板减
12、少性紫癜 E.白细胞总数增加5.The diagnosis of hyperthyroidism A.高代谢症状和体征 B.甲状腺肿伴或不伴血管杂音 C.血清FT4增高 D.TSH减低 E.高代谢体征6. The diagnosis of Graves disease A.甲亢诊断成立 B.甲状腺肿大成弥漫性 C.伴浸润性突眼 D. TRAb 和TSAb阳性 E.胫前粘液性水肿7. Hyperthyroidism and thyroiditis-induced thyrotoxicosis resulting in leakage of thyroid hormone-induced iden
13、tification A.病史 B.甲状腺体征 C. 131I摄碘率 D.FT3FT4 E.ECT8. Inhibit the synthesis of thyroid hormone drug A.硫脲类 B.咪唑类 C.-受体阻滞剂 D.激素 E.碘剂9. Indication for drug treatment of hyperthyroidism A.孕妇 B.术前准备 C.年龄20岁 D.甲状腺轻中度肿大 E.压迫症状10. Adverse effects of drug treatment of hyperthyroidismA.粒细胞减少 B.皮疹 C.中毒性肝炎 D.胆汁淤积
14、性黄疸 E.急性关节炎11. The characteristic of Hyperthyroidism crisis A. 多见于感染，各种应急时 B. 最常见于131I治疗的后期 C. 可能与交感神经兴奋有关D. 心率一般在120140次/分 E. 可伴心衰和肺水肿 甲状腺疾病习题答案一、单选题答案1.C 2.C 3.A 4.A 5.D 6.B 7.B 8.B 9.E 10.A 11.B 12.C二、多选题答案1.ABCDE 2.CD 3.ABCDE 4.ABCD 5.ABCDE 6.ABCDE 7.ABCDE 8.AB 9.ABCDE 10.ABCDE 11. ACE三名词解释答案：1.
15、简称甲亢，是指甲状腺腺体本身产生甲状腺激素过多而引起的甲状腺毒症，其病因包括弥漫性毒性甲状腺肿、结节性毒性甲状腺肿和甲状腺自主高功能腺瘤。2.也称为TSH结合抑制性免疫球蛋白，是存在于GD患者血清中的针对甲状腺细胞TSH受体的特异性自身抗体。3.甲亢患者在原有临床表现的基础上出现心律失常、心脏增大和心力衰竭。以心房颤动等房性心律失常多见，偶见房室传导阻滞。4.本症需在排除其它能够抑制TSH水平的疾病的前提下，依赖实验室检查结果才能诊断，即血清T3、T4正常，但是TSH减低。5.多见于老年患者，起病隐袭，高代谢综合征、眼征和甲状腺肿均不明显。主要表现为明显消瘦、心悸、乏力、头晕、昏厥、神经质或神
16、志淡漠、腹泻、厌食。可伴有心房颤动、震颤和肌病等体征，70%患者无甲状腺肿大。临床中易被误诊。四简答题答案：1.TRAb分为三种类型即TSH受体刺激性抗体（TSAb）TSH刺激阻断性抗体（TSBAb）和甲状腺生长免疫球蛋白（TGI）2. Graves病中易被检测出的三种甲状腺抗体为TSH受体抗体（TRAb）甲状腺过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TgAb）3.针对眶后成纤维细胞的自身抗体和针对眼外肌的自身抗体这两种抗体可作为Graves眼病活动的标志。4.发病诱因包括剧烈运动、高碳水化合物饮食、注射胰岛素等。5.周围血淋巴细胞比例增加，单核细胞增加，但是白细胞总数减低。可以伴发血
17、小板减少性紫癜。6.妊娠、雌激素、急性病毒性肝炎、先天因素等可以引起TBG升高，导致T T4增高；雄激素、糖皮质激素、低蛋白血症、先天因素等可以引起TBG降低，导致T T4 减低。7.血清TSH是反映甲状腺功能的最敏感的指标。8. 131I摄取率增高见于Graves病，131I摄取率减低见于亚急性甲状腺炎。9.高代谢症状和体征 ；甲状腺肿伴或不伴血管杂音；血清FT4增高、TSH减低。具备以上三项诊断即可成立。10.粒细胞减少 皮疹 胆汁淤积性黄疸、血管神经性水肿、中毒性肝炎 、急性关节炎等。11.可能与循环内FT3水平增高，心脏和神经系统的儿茶酚胺激素受体数目增加、敏感性增强有关。12.主要诱
18、因有感染、手术、放射碘治疗、创伤、严重的药物反应、心肌梗死等。五论述题答案：1.单纯性眼征包括下述表现：轻度突眼：突眼度不超过18mm；Stellwag征：瞬目减少，炯炯发亮；上睑挛缩，睑裂增宽；von Graefe征：双眼向下看时，由于上眼睑不能随眼球下落，出现白色巩膜；Joffroy双眼向上看时，前额皮肤不能皱起；Mobius征：双眼看近物时，眼球辐辏不良。2.Graves病特殊临床表现有甲状腺危象甲状腺功能亢进性心脏病淡漠型甲状腺功能亢进症三碘甲腺原氨酸（T3 ）型和甲状腺素（T4 ）型甲状腺毒症亚临床甲状腺功能亢进症妊娠期甲状腺功能亢进症胫前粘液性水肿Graves眼病3.适应症为病情轻
19、中度患者；甲状腺轻中度肿大；年龄20岁；孕妇高龄或由于其它严重疾病不适宜手术者；手术前或放射碘治疗前的准备；手术后复发且不适宜放射碘治疗者。4.抗甲状腺药物可分为硫脲类和咪唑类两类，硫脲类包括丙硫氧嘧啶和甲硫氧嘧啶；咪唑类包括甲硫咪唑和卡比马唑。5. 临床表现为原有的甲亢症状加重，包括高热（39以上）、心动过速（140240次/分）、伴心房颤动或心房扑动、烦燥不安、呼吸急促、大汗淋漓、厌食、恶心、呕吐、腹泻等，严重者出现虚脱、休克、嗜睡、谵妄、昏迷，部份患者有心力衰竭、肺水肿，偶有黄疸。6.甲亢危象的抢救原则1) 针对诱因治疗2) 抑制甲状腺激素合成：首先PUT600mg口服，以后250mg每6小时口服，症状缓解时减至一般治疗量。3) 抑制甲状腺激素释放：复方碘溶液5滴，每8小时一次口服。4) 普萘洛尔2040mg每68小时口服一次。5) 氢化可的松50100mg加入5%10%葡萄糖溶液静滴，每68小时一次。6) 降低和清除血浆甲状腺激素：腹膜透析、血液透析或血浆置换治疗。7) 降温8) 其它支持治疗。
