【東邦大（医）】次の英文を読み，設問 1~17 に最も適する答を，(a) ~ (d) の中から一つ選べ．

Gout is a form of acute arthritis that causes (1)severe pain and swelling in the joints.
It most commonly affects the big toe, but may also affect the heel, ankle, hand, wrist, or elbow.
It affects the spine often enough to be a factor in back pain.

Gout usually comes on suddenly,

goes away after 5-10 days, and can keep recurring. (2)Gout is different from other forms of5arthritis because it occurs when there are high levels of uric acid circulating in the blood,
which can cause urate crystals to settle in the tissues of the joints.
Uric acid, which is found naturally in the blood stream, is formed as the body breaks
down waste products, mainly those containing purine, a (3)substance that is produced by
the body and is also found in high concentration in some foods, including brains, liver,10

sardines, anchovies, and dried peas and beans. Normally, the kidneys filter uric acid out of
the blood and excrete it in the urine.

Sometimes, however, the body produces too much uricacid or the kidneys aren't efficient enough at filtering it from the blood, and it builds up in
the blood stream, a condition known as hyperuricemia.

A person's susceptibility to gout

may increase because of the inheritance of certain genes or from being overweight and eating
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a rich diet.
Hyperuricemia doesn't always cause gout.

Over the course of years, however,sharp urate crystals build up in the synovial fluid of the joints. Often, some precipitating
event, such as an infection, surgery, the stress of hospitalization, a stubbed toe, or even aheavy drinking binge can cause inflammation.
20(4)White blood cells, mistaking the urate

crystals for a foreign invader, flood into the joint and surround the crystals, causing
inflammation — in other words, the redness, swelling, and pain that are the hallmarks of agout attack.
As a result of high levels of uric acid in the blood, needle-like urate crystals gradually(5)accumulate in the joints. Urate crystals may be present in the joint for a long time

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without causing symptoms.

Infection, injury to the joint, surgery, drinking too much, oreating the wrong kinds of foods may suddenly bring on the symptoms, which include pain,tenderness, redness, warmth, and swelling of the joint.
begins in the middle of the night.

In many cases, the gout attack

The pain is often so excruciating that the sufferer cannot

bear weight on the joint or (6)tolerate the pressure of bedcovers. The inflamed skin over30

the joint may be red, shiny, and dry, and the inflammation may (7)be accompanied by amild fever. These symptoms may go away in about a week and disappear for months oryears at a time. However, over the course of time, attacks of gout (8)recur more and more
frequently, last longer, and affect more joints.

Eventually, stone-like deposits known as

tophi may build up in the joints, ligaments, and tendons, leading to (9)permanent joint
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deformity and decreased motion.
Usually, physicians can diagnose gout based on the physical examination andmedical history (the patient's description of symptoms and other information).

Doctors canalso administer a test that measures the level of uric acid in the blood. (10)While normal
uric acid levels don't necessarily rule out gout and high levels don't confirm it, the presence
40of hyperuricemia increases the likelihood of gout. The development of a tophus can confirm
the diagnosis of gout. The most (11)definitive way to diagnose gout is to take a sample offluid from the joint and test it for urate crystals.
The goals of treatment for gout consist of alleviating pain, avoiding severe attacks
in the future, and preventing long-term joint damage.

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In addition to taking pain

medications as prescribed by their doctors, people having gout attacks are encouraged to rest
and to increase the amount of fluids that they drink.
Once an acute attack has been successfully treated, doctors try to prevent futureattacks of gout and long-term joint damage by lowering uric acid levels in the blood.

Goutcannot be cured but usually it can be managed successfully. As tophi (12)dissolve, joint
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mobility generally improves.

Lowering uric acid in the blood also helps to prevent or

improve the kidney problems that may accompany gout.

-2-1. The word (1)“severe” is closest in meaning to(a) strict(b) distinctive(c) full(d) extreme

2. Which of the following sentences is closest in meaning to the underlined part (2)?
(a) High levels of uric acid producing in the blood are produced by a different form ofarthritis, which will cause urate crystals to gather in the joints and may cause gout.
(b) What makes gout different from other forms of arthritis is that the urate crystals
settle in the joint tissues rather than in the blood circulation.
(c) Gout is caused by an excess of uric acid in the blood, which leads to the buildup ofurate crystals in the joint tissues and distinguishes it from other types of arthritis.
(d) Gout is caused by urate crystals in the joint tissues, while other forms of arthritis
are caused by high levels of uric acid in the blood.

3. The word (3)“substance” is closest in meaning to(a) poison(b) density(c) material(d) content

4. Which of the following sentences is closest in meaning to the underlined part (4)?
(a)

White blood cells cause redness, swelling, and pain by inflaming the joint whereurate crystals have built up because they react as if the urate crystals are foreign
invaders.
(b) White blood cells mistakenly invade the joint and surround the urate crystals in
response to the redness, swelling, and pain of inflammation.
(c) Redness, swelling, and pain cause urate crystals to invade the joint from outside,which attracts white blood cells to the area of inflammation by mistake.
(d) Urate crystals are mistakenly surrounded by foreign invaders, which attract whiteblood cells that cause inflammation, producing the redness, swelling, and pain of agout attack.

-3-5. The word (5)“accumulate” is closest in meaning to(a) circulate(b) degrade(C)ache(d) gather

6. The word (6)“tolerate” is closest in meaning to(a) condone(b) endure(c) permit(d) sustain

7. The phrase (7)“be accompanied by” is closest in meaning to(a) attend to(b) be caused by(c) occur with(d) be parted from

8. The word (8)“recur” is closest in meaning to(a) return(b) react(c) respond(d) restore

9. The word (9)“permanent” is closest in meaning to(a) inlexible(b) impossible(c) irreversible(d) feasible

10. Which of the following sentences is closest in meaning to the underlined part (10)?
(a) Gout can be confirmed if there is a likelihood of hyperuricemia, if to0 much uricacid is present in the blood, or if normal levels of uric acid are ruled out.
(b) The presence of hyperuricemia makes gout more likely, but only if normal levels ofuric acid are ruled out or if high levels of uric acid are confirmed.
(c)

A regular level of uric acid can rule out gout since a high level is necessary toconfirm the likelihood of hyperuricemia, which is necessary for gout to be present.
(d) Hyperuricemia makes the possibility of gout higher, but gout can still be present
with regular levels of uric acid or may not be present even if the level of uric acid isabove normal.

-4-11. The word (11)“definitive” is closest in meaning to(a) conclusive(b) current(c) scientific(d) differential

12. The word (12)“dissolve” is closest in meaning to(a) take off(b) break down(c) come together(d) stretch out

13. According to the text, hyperuricemia is caused by(a) uric acid being excreted in the urine.
(b) the kidneys not being able to filter enough uric acid from the blood.
(c) the body converting urate crystals into purines.
(d)heavy drinking, infection, surgery, or hospitalization.

14. According to the text, the buildup of urate crystals in the joints(a) does not always cause the symptoms of gout right away.
(b) may begin in the middle of the night.
(c) does not always lead to hyperuricemia.
(d) may require surgery.

15. According to the text, gout attacks(a) occur less often over time.

(b)

are brought on by excruciating pain.

(c) may happen suddenly.

(d) rarely occur at night.

16. According to the text, gout is diagnosed by(a) checking the affected joint for urate crystals.
(b) looking for the development of a tophus.
(c) measuring how much uric acid is in the blood.
(d)

all of the above.

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17. According to the text, after the initial gout attack has been taken care of, the goal oflater treatment is to(a) increase the amount of fluids the patient drinks.
(b) eliminate uric acid from the blood.
(c) stop attacks from coming again.
(d)provide a permanent cure.

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