In a poor, inland, gang-infested part of Los Angeles, there is a clinic for people with type 1 diabetes. As part of the country health care system, it serves persons who have fallen through all other safety-net options, the poorest of the poor. Although type 2 diabetes is rampant in this part of town, type 1 diabetes exists as well. Yet these latter individuals generally lack access to any specialty care—a type of treatment they desperately need due to the complexity of dealing with type 1 diabetes in the setting of poverty and psychosocial stress.
The Type 1 Clinic meets one morning per week and is staffed by four endocrinology fellows and a diabetologist, often me. I have the unique perspective of working part of the time in a county setting and the other part of the time in a clinic for people with health insurance, in Beverly Hills. I know what is possible in the treatment of type 1 diabetes. East Los Angeles teaches me what happens when access to care is not available. Most of our patients, in their 20s and 30s and 40s, already have complications of their diabetes; many near end stage. Concepts about maintaining near-normal blood glucose levels often miss their mark—lack of education or money or motivation or factors I can’t even imagine make the necessity of a patient acting as his or her own exogenous pancreas nearly impossible, especially when there are acute consequences to hypoglycemia and few to moderate hyperglycemia.
Historically, in spite of these barriers, we persisted and thought we made a difference. Often, teaching simple carbohydrate counting or switching therapy to long-acting insulin improved patients control and their quality of life. The fellows felt they made a positive impact in the health of their patients. Driving home I would be encouraged by what we had accomplished, although saddened by the severity of the complications suffered by many of our patients.
Yet everything changed with the recession of 2008. In Beverly Hills I heard a lot about the demise of the financial markets. Patients of mine had invested with Bermie Madoff. Some, once billionaires, were now millionaires. Personal assistants and housekeepers were laid off, vacation homes were put on the market, and parties became less lavish. But all still live in safe, clean homes, wear designer clothes, and eat high-quality food. The landscape is very different for many of my East LA patterns. The temporary, part-time jobs they had cobbled together to keep food on the table and pay for housing are gone. I—naively—didn’t realize how much worse poverty could get. But now many of our patients are young without food and are becoming homeless. One young man, a college student trying to work his way out of poverty by going to school, lost his job and is living in his car. He is still taking classes but is unable to afford more than a dollar meal from a fast-food restaurant once every day or two. Management of his diabetes involves simply keeping him alive with his erratic, poor eating habit.
1.At the beginning, the author describes the patients with an emphasis on （ ）.
2.As a diabetologist working for the Type 1 Clinic, the author is quite concerned about those who （ ）.
3.Not until the recession of 2008 did the medical staff （ ）.
4.As witnessed by the dialectologist during the recession of 2008, many poor patients （ ）.
5.Which of the following tones does the passage most probably carry?
问题1选项
A.their financial status
B.their living in injustice
C.their specialty care of any kind
D.their ignorance of type 1 diabetes
问题2选项
A.misunderstand the concepts on blood glucose maintenance
B.have no ideas about what medical problem they are having
C.don’t care about acting as their own exogenous pancreas
D.lack access to property and sufficient clinical care
问题3选项
A.feel proud of their dedication and persistence in clinical practice
B.know how severe the complications of type 1 diabetes could be
C.regret about more they could have done for the patients
D.feel a sense of accomplishments in treating the patients
问题4选项
A.developed poor eating habits with the progression of type 1 diabetes
B.struggled with their survival, let alone with their medical care
C.became loser in the investment with Bernie Madoff
D.switched from full-time to part-time jobs
问题5选项
A.Indifference.
B.Sympathy.
C.Passion.
D.Guilt.
第1题:A
第2题:D
第3题:B
第4题:B
第5题:B
第1题:
【选项释义】
At the beginning, the author describes the patients with an emphasis on（ ）. 在文章的开头，作者对患者进行了描述，重点是____。
A. their financial status A. 他们的财务状况
B. their living in injustice B. 他们的生活不公平
C. their specialty care of any kind C. 他们任何形式的专业护理
D. their ignorance of type 1 diabetes D. 他们对1型糖尿病的无知
【答案】A
【考查点】推理判断题。
【解题思路】根据题干信息可定位到第一段该处讲到“在洛杉矶一个贫穷、内陆、帮派出没的地区”以及“穷人中的最穷的人提供服务”和“由于在贫困和社会心理压力的环境下处理1型糖尿病的复杂性，他们迫切需要这种治疗。”，可知开头作者重点描述了他的患者十分的贫穷，因此选A。
【干扰项排除】
B选项“他们的生活不公平”，文章只说他们的生活很贫穷没有体现不公平，该选项属于无中生有；
C选项“他们任何形式的专业护理”，文中第一段提到“虽然2型糖尿病在这个地区很猖獗，但1型糖尿病也存在。然而，后者通常缺乏任何专业护理”，这些患者是缺乏任何形式的专业护理的，该选项属于反向干扰；
D选项“他们对1型糖尿病的无知”，文中没有体现，该选项属于无中生有。
第2题:
【选项释义】
As a diabetologist working for the Type 1 Clinic, the author is quite concerned about those who（ ）. 作为一名在Type 1诊所工作的糖尿病专家，作者非常担心____。
A. misunderstand the concepts on blood glucose maintenance A. 那些误解血糖维持概念的人
B. have no ideas about what medical problem they are having B. 对自己的健康问题一无所知的人
C. don’t care about acting as their own exogenous pancreas C. 不关心充当自己的外源性胰腺的人
D. lack access to property and sufficient clinical care D. 缺乏财产和足够的临床护理的人
【答案】D
【考查点】事实细节题。
【解题思路】根据题干关键词diabetologist working for the Type 1 Clinic可以定位到文章第一段的Yet these latter individuals generally lack access to any specialty care—a type of treatment they desperately need due to the complexity of dealing with type 1 diabetes in the setting of poverty and psychosocial stress.（然而，这些后者通常无法获得任何专科护理——由于在贫困和社会心理压力下处理1型糖尿病的复杂性，他们迫切需要这种治疗。）和第二段的East Los Angeles teaches me what happens when access to care is not available.（东洛杉矶让我明白，当无法获得医疗服务时会发生什么。），这些句子都直接表明了作者对患者缺乏医疗服务和护理的担忧。因此D选项正确。
【干扰项排除】
A选项“那些误解血糖维持概念的人”，文中没有提及，属于无中生有；
B选项：文章没有信息表明作者担忧患者对自己的疾病一无所知。相反，文章暗示患者知道自己患有糖尿病，只是难以管理，属于反向干扰；
C选项“不关心充当自己的外源性胰腺的人”，文中提到是“使患者几乎不可能充当自身的外源性胰腺”并不是不关心，因此该选项属于过度推断。
第3题:
【选项释义】
Not until the recession of 2008 did the medical staff（ ）. 直到2008年的经济衰退，医务人员才____。
A. feel proud of their dedication and persistence in clinical practice A. 为他们在临床实践中的奉献和坚持感到自豪
B. know how severe the complications of type 1 diabetes could be B. 知道1型糖尿病的并发症有多严重
C. regret about more they could have done for the patients C. 后悔他们本可以为病人做得更多
D. feel a sense of accomplishments in treating the patients D. 在治疗病人方面才有了成就感
【考查点】事实细节题。
【解题思路】根据题干信息可定位到第三段“我为我们取得的成就感到鼓舞，但也为许多病人所遭受的严重并发症感到悲伤”因为作者治疗的是1型糖尿病因此可知遭受的是1型糖尿病的并发症。因此选B。
【干扰项排除】
A选项“为他们在临床实践中的奉献和坚持感到自豪”，文中没有提及，属于无中生有；
C选项“后悔他们本可以为病人做得更多”，并不是到2008年医务人员才后悔本可以做得更多，该选项属于过度推断；
D选项“在治疗病人方面才有了成就感”，文中提到“我为我们取得的成就感到鼓舞”，但并不是直到2008年经济衰退医务人员才有了成就感，该选项属于过度推断。
第4题:
【选项释义】
As witnessed by the diabetologist during the recession of 2008, many poor patients（ ）. 正如这位糖尿病学家在2008年经济衰退期间所见证的那样，许多贫困患者____。
A. developed poor eating habits with the progression of type 1 diabetes A. 随着1型糖尿病的发展而养成不良的饮食习惯
B. struggled with their survival, let alone with their medical care B. 为了生存而挣扎更别说医疗了
C. became loser in the investment with Bernie Madoff C. 在麦道夫的投资中成为输家
D. witched from full-time to part-time jobs D. 从全职工作转向兼职工作
【答案】B
【考查点】推理判断题。
【解题思路】根据题干信息可定位到最后一段最后一句“对他糖尿病的控制仅仅只是在他不规律不健康的饮食习惯下维持生命。”也就是说，他们的生计都成问题，更不用说医疗护理了，所以选项B符合原文。
【干扰项排除】
A选项“随着1型糖尿病的发展而养成不良的饮食习惯”，是因为贫穷导致没有钱维持生计，所以治疗糖尿病的方法是维持不稳定、不良的饮食习惯，这种饮食习惯根本上是因为贫穷而不是糖尿病的发展，该选项本末倒置；
C选项“在麦道夫的投资中成为输家”，指的是那些富有的人，不是贫困患者，该选项属于张冠李戴；
D选项“从全职工作转向兼职工作”，文中没有提及，该选项属于无中生有。
第5题:
【选项释义】
Which of the following tones does the passage most probably carry? 这篇文章最有可能表达下列哪一种语气？
A. Indifference. A. 冷漠。
B. Sympathy. B. 同情。
C. Passion. C. 激情。
D. Guilt. D. 内疚。
【答案】B
【考查点】主旨大意题。
【解题思路】文章第一段说到“穷人中的最穷的人提供服务”以及“由于在贫困和社会心理压力的环境下处理1型糖尿病的复杂性，他们迫切需要这种治疗。”提出这类穷人目前非常需要治疗的状况；第二段说到“让一个病人作为他或她自己的外源胰腺几乎是不可能的，特别是当有低血糖和中轻度高血糖的严重后果时。”表明一些穷人甚至都不清楚自己的健康状况；第三段说到“为许多病人所遭受的严重并发症感到悲伤。”，表示作者在治疗这些贫困患者时的同情；第四段讲2008年以后由于经济衰退，贫穷的患者更加贫穷，无法维持生计更不用说治疗疾病。综合全文，作者作为一个糖尿病治疗医生，全文表达了他对穷困患者的同情。因此B正确。
【干扰项排除】
A选项“冷漠。”，与作者的口气相反，属于反向干扰；
C选项“激情。”，文中没有体现，属于过度推断；
D选项“内疚。”，文中没有体现，属于过度推断。
【参考译文】
在洛杉矶内陆一个贫穷且帮派横行的地区，有一家为1型糖尿病患者开设的诊所。作为国家医疗保健系统的一部分，它的服务对象是那些所有其他安全网都未能覆盖的人，也就是穷人中最穷的人。虽然2型糖尿病在这一地区十分猖獗，但1型糖尿病患者也同样存在。然而，由于在贫困和社会心理压力的环境下处理1型糖尿病的复杂性，这些人通常无法获得任何专科护理——一种他们迫切需要的治疗。
1型糖尿病诊所每周开诊一个上午，由四名内分泌学研究员和一名糖尿病医生（通常是我）组成。我有一个独特的视角，一部分时间在县医院里工作，另一部分时间在比佛利山庄为有医疗保险的人开设的诊所工作。我知道治疗1型糖尿病的可能性有多大。东洛杉矶教会了我在无法获得医疗服务时会发生什么。我们的大多数病人都是20多岁、30多岁和40多岁，已经出现糖尿病并发症；许多人已经接近晚期。关于维持接近正常血糖水平的概念往往失之偏颇——缺乏教育、金钱、动力或我无法想象的因素，使得患者几乎不可能充当自己的外源胰腺，尤其是当低血糖和轻度至中度高血糖造成急性后果时。
从历史上看，尽管存在这些障碍，我们还是坚持了下来，并认为我们做出了改变。通常情况下，教授简单的碳水化合物计算方法或改用长效胰岛素治疗可改善患者的血糖控制和生活质量。研究员们认为，他们对患者的健康产生了积极影响。开车回家的路上，我会为我们所取得的成就感到鼓舞，但也会为许多患者所遭受的严重并发症感到难过。
然而，2008年的经济衰退改变了一切。在比佛利山庄，我听到了很多关于金融市场崩溃的消息。我的病人曾在伯纳德·麦道夫那里投资。有些人曾经是亿万富翁，现在成了百万富翁。私人助理和管家纷纷下岗，度假屋被挂牌出售，派对也变得不再奢华。但他们仍然住在安全、干净的房子里，穿着名牌服装，吃着高品质的食物。对我在东洛杉矶的许多朋友来说，情况却大不相同。他们为了维持生计和支付房租而拼凑起来的临时兼职工作已经一去不复返了。我天真地没有意识到贫困会变得如此严重。但现在，我们的许多病人年纪轻轻就失去了食物，变得无家可归。有一位年轻人是一名大学生，试图通过上学摆脱贫困，但他失去了工作，只能住在自己的车里。他还在上课，但只能每隔一天两天负担得起快餐店的一美元餐。控制他的糖尿病仅仅是为了在他不规律、糟糕的饮食习惯下维持他的生命。
