【評論主題】19.有關聽神經瘤（acoustic neuroma）的臨床敘述，下列何者錯誤？(A)比較正確的名稱應為前庭神經鞘瘤、許旺氏細胞瘤（vestibular schwannoma）(B)最常見的臨床症狀是

【評論內容】Facial nerve palsy要想parotid tumor, tumors in temporal bone, like CN7 neuroma, meningioma, hemangioma, Malignant primary and metastatic lesions

【評論主題】3.下列何者不是器官移植之後使用的抗排斥藥物？(A)basiliximab(B)rabbit antithymocyte globulin(C)tacrolimus(D)valacyclovir

【評論內容】

疱疹感染無法醫治，因為疱疹病毒已進入神經，潛伏在神經根，強力的抗疱疹藥物acyclovir（Zovirax）、famciclovir（Famvir）、以及valacyclovir (Valtrex)可防止大多數的爆發，但並沒有消除隱藏在神經細胞中的病毒

---[WebMD]疱疹藥物無法阻止疱疹散播@ 快樂小藥師Im pharmacist nichts

看看故事;

在1985 年，第一個單株抗體，OKT3，開始應用在臨床上作為抗排斥治療的引導劑以及用來治療急性排斥，到1990 年代，很多醫學中心的腎臟移植一年存活率已經可以達到90%。1990 年代早期，tacrolimus 開始被使用在器官移植上而得到可以和cyclosporine 比擬的移植器官以及病人的存活率。接下來mycophenolate mofetil 也被發現在同時伴隨cyclosporine 及類固醇使用的情況下， 比azathoprine 更能有效降低急性排斥的發生率。

--免疫抑制劑, 李志元 蔡孟昆

【評論主題】6.下列何者是治療麻醉氣體引起的惡性高溫（malignant hyperthermia）最主要的藥物？(A)propranolol(B)dantrolene(C)doxazosin(D)nifedip

【評論內容】

惡性高熱較好發於男性，男女的比例約是2:1，目前已知至少有6個基因與惡性高熱有關。雖然惡性高熱是顯性遺傳，但患者於日常生活中完全不受影響，必須遇上特定因子才會被觸發，使鈣離子源源不絕地流進到肌肉細胞內，導致惡性高熱。最常見的觸發因子是用於全身麻醉的麻醉性氣體及去極化肌肉鬆弛劑。

倘若遇上不曉得自己帶有惡性高熱，而在麻醉過程中發作的患者要立刻關掉觸發藥物，並施打目前唯一的解藥「單挫林（Dantrolene）」。

然而大家可能不曉得，台灣大多數的醫院連1支單挫林都沒有。從麻醉醫學會網站上公布的庫存清單中可以發現台灣470餘間醫院中僅有20餘間醫院備有單挫林。小型地區醫院也就罷了，可是規模大、手術量多的區域醫院中備有單挫林的醫院竟然也屈指可數，甚至連部分醫學中心都沒有準備單挫林。

【評論主題】4.下列何者不是脫離呼吸器（weaning from ventilator）的條件？(A)呼吸速率 < 25 / minute(B)動脈血氧氣分壓（ PaO2）＞ 70 mmHg（FiO240%

【評論內容】Parameter Normal Adult Range Weaning Threshold Utility Rate/Tidal Volume < 50/min/L <105/min/L High (+/-) Max Inspiratory Pressure -90 cm (F); – 120 (M) – 25 cm H2O High (- only) PaO2/FiO2 400 200 unknown Tidal Volume 5 – 7 mL/kg 5 mL/kg unknown Respiratory Rate 14 – 18 < 40 unknown Vital Capacity 65 – 75 mL/kg 10 mL/kg unknown Minute Ventilation 5 – 7 L/min < 10 L/min Very Poor (~ 50%)

【評論主題】2.外傷病人使用各種輸液及血液製品來復甦急救，其目的在於使人體各個組織都能得到充足組織灌流（tissueperfusion）。尿液的排出量為一客觀實用之定量指標，則下列何者為正確指標？(A)成人大於1

【評論內容】

The normal range for 24-hour urine volume is 800 to 2000 milliliters per day (with a normal fluid intake of about 2 liters per day).

Oliguria is urine output < 500 mL in 24 h (0.5 mL/kg/h) in an adult.Oliguria is urine output < 1 L in 24 h (1 mL/kg/h) in a child.

One definition (RIFLE consensus definition of the Acute Dialysis Quality Initiative) of risk of AKI being <0.5 cc/kg/hr for 6+ hours, injury of AKI if <0.5 cc/kg/hr for 12+ hours, and failure if <0.3 cc/kg/hr for 24+ hours (or anuric for 12 hours)...

【評論主題】18.50歲男性主訴左耳反覆耳漏及聽力損失超過10年，局部檢查後，安排高解析度電腦斷層攝影，結果如下：在上鼓室有一軟組織包圍聽小骨（如下圖），最有可能之診斷為何？ (A)積液性中耳炎(B)乳突炎(C)

【評論內容】一名35歲的女性多年來左耳不斷反覆流膿，一直以為是中耳炎，但直到出現臉皮脹痛、眼皮睜不開、嘴巴歪斜並且有暈眩的情況，再作檢查才發現是中耳膽脂瘤惹的禍；膽脂瘤會侵襲骨頭，嚴重時恐破壞聽小骨、三半規管、顏面神經，更嚴重時恐侵襲顱底骨，恐導致腦膜炎，造成生命危險；提醒如果中耳炎藥物治療2周後未改善，應及早就醫處理。收治這名女性的萬芳醫院耳鼻喉科主治醫師曾智傑表示，膽脂瘤和中耳炎一樣，都容易有流水、流膿、耳朵悶塞感，因此常常只被當作中耳炎復發處理；膽脂瘤是反覆中耳炎，角質堆積產生的發炎物質導致的疾病，發炎物質會侵蝕骨頭，嚴重時恐破壞聽小骨、三半規管、顏面神經；這名女士主管面部表情的顏面神經和主管平衡的三...

【評論主題】17.40歲的女性病患主訴反覆眩暈發作數年，病史中得知每次發作都有懼光（photophobia）或懼音（phonophobia），且常常發作都與月經期有關。當食用乳製品（dairy products如

【評論內容】http://www.neuropt.org/docs/vsig-english-pt-fact-sheets/migraine-diet-triggers.pdfThe list of foods that have been reported to cause migraine symptoms is quite long. But the most common foods are MSG (monosodium glutamate), aged cheese, red wine and beer, and chocolate. These foods contain substances called amines that are thought to trigger migraine symptoms in some people. There are many websites that provide lists of foods containing the different amines in great detail. The more common foods that have been identified as triggering a migraine may be summarized as follows:Cheeses that are...

【評論主題】3.36歲有抽菸男性，因胸痛來到急診，胸痛已有八個小時，會傳向雙側上臂，且胸痛會因吸氣而加重，躺下時更嚴重，在坐起時上半身略向前傾會好一些。身體診察血壓140/72毫米汞柱，心跳每分鐘96次，沒用氧氣

【評論內容】CHEST PAIN

MI 與 pericarditis 區分

Unlike pain from myocardial ischemia, chest pain due to pericarditis is most often sharp and pleuritic in nature, with exacerbation by inspiration or coughing. One of the most distinctive features is the tendency for a decrease in intensity when the patient sits up and leans forward.

This position (seated, leaning forward) tends to reduce pressure on the parietal pericardium, particularly with inspiration, and may also allow for splinting of the diaphragm.

Radiation of chest pain to the trapezius ridge has also been considered to be fairly specific for pericardi...

【評論主題】6.一位病人發現其小便像濃茶，至醫院就醫時，醫師也在身體診察中確認其皮膚及鞏膜有泛黃現象，小便檢驗發現bilirubin（3+）。下列各項檢查或檢驗，何者最不具診斷效益？(A)腹部超音波檢查(B)抽血

【評論內容】

For clinical purposes, serum bilirubin is fractionated to classify hyperbilirubinemia into one of two major categories

●Plasma elevation of predominantly unconjugated (indirect) bilirubin. This may be due to the overproduction of bilirubin, impaired bilirubin uptake by the liver, or abnormalities of bilirubin conjugation (algorithm 1).

●Plasma elevation of both unconjugated and conjugated (direct) bilirubin. This may be due to hepatocellular disease, impaired canalicular excretion of bilirubin, or biliary obstruction (algorithm 2). This is often referred to as conjugated hyperbilirubinemia, ev...

【評論主題】1.下列與腹部腔室症候群（abdominal compartment syndrome）相關的症狀，何者錯誤？(A)腹內壓突然增加(B)小便量減少(C)缺氧（hypoxia）(D)血壓正常

【評論內容】

一般人在自然呼吸時所量測的腹內壓力為0mmHg，在重病患者腹內壓力會增加至4-10mmHg。定義上，若量測得的腹內壓力持續大於10mmHg 稱為腹內高壓(IAH)，若合併器官受損稱為腹部腔室症候群(ACS)。

s/s

小便減少、膚唇發紺、呼吸喘、快、費力、血氧濃度下降的情況，腹部檢查呈現脹大而僵硬的腹部，皮膚出現「大理石斑紋」樣的暗青花斑。

【評論主題】2.全身麻醉期間使用氣管內管（endotracheal tube），應以壓力計測量其cuff pressure，並應保持下列何者合理壓力，以預防病人吸入胃液與附近組織缺血？(A)18 cmH2O(B)

【評論內容】

可見其安全的壓力在20~30 cmH2O之間

【評論主題】2.90歲的林奶奶患有血管性的失智症，近日來日夜顛倒，晚上無法睡覺，常常想要開門出去，外勞有時都拉不住，家人感到非常無助，來到門診尋求幫忙。下列有關失智症的敘述，何者正確？(A)血管性的失智症是最常見

【評論內容】

(A) 理論上對

和西方國家相同，台灣的失智症社區研究發現阿茲海默氏病是當中最常見的類型 。但是兩起醫院的調查卻發現醫院中求診的病患，血管性失智症的比例高於阿茲海默氏病 。

社區調查和醫院調查不同的原因目前仍不清楚，可能是社區研究沒有將每位診斷為失智症的病患都進行影像檢查，因此低估了血管性失智症的盛行率。另外，也可能是血管性失智症死亡率較高，也因合併有其他疾病如高血壓、糖尿病等，而求醫機會較高。

失智症之類型在社區中，以阿爾滋海默氏病(Alzheimer'5 disease, AD)為主，約佔半數；其次為血管型失智症（Vascular dementia, VaD約20～25%）及混合型失智症（約5-10%）。

ref: Liu HC, tsou HK, Lin KN, et al:Evaluation of ...

【評論主題】1.一位病人血液氣體分析顯示pH 7.51，PaCO249 mmHg，HCO3- 38 mmol/L，下列何者正確？(A)代謝性酸中毒（酸血症）(B)代謝性鹼中毒(C)呼吸性酸中毒(D)呼吸性鹼中毒

【評論內容】

pH正常值:7.35~7.45

此人偏鹼 (Alkalosis)PaO2 正常值:80-100mmHgpaCO2 正常值:35~45  mmHgHCO3- 正常值 : 22-26 meq / L此人CO2高、HCO3-高PaCO2上升：可能是resp. acidosisHCO3–上升：可能是met. alkalosis判讀時要注意primary disorder，也就是先看pH值。現在pH值是鹼性，所以呼吸造成的酸要當成代償。原發是一個代謝性的鹼中毒。再來要看代償成功與否。要代公式：Met. alkalosis：ΔPaCO2 = 0.7 * ΔHCO3–代償正常的ΔPaCO2 = 0.7 x 14 = 9.8此病人的ΔPaCO2 = 9ΔPaCO2比預期的還要低，可以算是合併resp. alkalosis，也就是他代償不過來了。--------------------------以下補充公式：Met. acidosis：ΔPaCO2 = 1.2 * ΔHCO3–Met. a...

【評論主題】76.下列何者為使用rapid sequence intubation（RSI）的禁忌？(A)躁動(B)癲癇發作(C)藥物過量(D)嚴重臉部外傷

【評論內容】Contraindications of RSIAbsolute

Total upper airway obstruction, which requires a surgical airway

Total loss of facial/oropharyngeal landmarks, which requires a surgical airway

Relative

Anticipated "difficult" airway, in which endotracheal intubation may be unsuccessful, resulting in reliance on successful bag-valve-mask (BVM) ventilation to keep an unconscious patient alive

In this scenario, techniques for awake intubation and difficult airway adjuncts can be used.

Multiple methods can be used to evaluate the airway and the risk of difficult intubation (eg, LEMON rule, 3-3-2, Mallampati class, McCo...

【評論主題】61.下一列那一條韌帶在踝關節扭傷發生率最高？(A)三角韌帶（deltoid ligament）(B)前脛腓骨韌帶（anterior tibiofibular ligament）(C)後距腓骨韌帶（p

【評論內容】

Lateral ankle sprain — The most common mechanism of ankle injury is inversion of the plantar-flexed foot (figure 2), which causes damage to the lateral ligament complex of the ankle. This ligament complex consists of the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament (figure 3). The ligaments within this complex are injured in a predictable sequence as forces increase.

The anterior talofibular ligament is the first or only ligament to be injured in the majority of ankle sprains. Stronger forces lead to combined ruptures of the anterior tal...

【評論主題】50.有關排卵藥clomiphene citrate敘述，下列何者錯誤？(A)主要可以治療促性腺激素低下型低性腺功能症（hypogonadotropic hypogonadism WHO group

【評論內容】

由於hypogonadotropic hypogonadism 是本身無法分泌FSH與LH，因此抑制雌激素的副回饋仍然無法解決問題。須解決其根本因素，如： brain or pituitary tumors, pituitary apoplexy, head trauma, ingestion of certain drugs, and certain systemic diseases and syndromes.

Mechanism of Action  (clomiphene)

Clomiphene is a racemic mixture consisting of zuclomiphene (~38%) and enclomiphene (~62%), each with distinct pharmacologic properties. Clomiphene acts at the level of the hypothalamus, occupying cell surface and intracellular estrogen receptors (ERs) for longer durations than estrogen. This interferes with rece...

【評論主題】42.依照International Continence Society所提出Pelvic Organ Prolapse Quantification system（POP-Q）不同部位缺陷之定量測

【評論內容】

POPQ measurements — Each point is located by measuring along the vaginal wall or identifying the most dependent point of a prolapsed structure. The measurement is then taken of the distance from the point to the hymenal plane. The anatomic location of each point is (figure 1) [20,21]:

●Anterior vaginal wall points:

•Point Aa is located in the midline of the anterior vaginal wall, 3 cm proximal to the external urethral meatus, corresponding approximately to the urethrovesical junction. The quantitative value of point Aa is anywhere from –3 to +3 cm from the hymenal plane, depending upon t...

【評論主題】27.30歲孕婦，妊娠42週，欲予引產，根據Bishop score評分其子宮頸成熟度，若子宮頸閉合，Effacement 10%，Station：-3，子宮頸硬度為堅硬（firm），並且子宮頸位於後

【評論內容】

A Bishop score ≥8 suggests the chances of having a vaginal delivery are good and the cervix is considered favorable or ripe for induction. If the Bishop score is low, variably defined as ≤3 to 6, the chances of having a vaginal delivery are lower, and the cervix is considered unfavorable or unripe for induction. A simplified Bishop score can be calculated using only dilation, station, and effacement. Using these three variables, a simplified Bishop score ≥5 has a similar predictive value for vaginal delivery as a classic Bishop score ≥8.

子宮頸閉合: 0

Effacement 10%: 0 

Station：-3...

【評論主題】9.下列關於視網膜胚細胞瘤（retinoblastoma）之敘述，何者錯誤？(A)是小兒最常見的眼內原發惡性腫瘤(B)最常出現的症狀為白色瞳孔（leukocoria）(C)與致病相關之基因（RB1）位

【評論內容】

眼球結構由鞏膜、脈胳膜及視網膜包成一個球體，內部充滿膠質，叫做玻璃體，正前方則是水晶體，視網膜母細胞瘤是從視網膜長出來的一種惡性腫瘤. 這種腫瘤比較罕見，應該是出生的時候已存在，只是在出生時未被發現，大約 80% 在 1 歲或 2 歲左右被診斷出來。在美國 5 歲以下的兒童每 100 萬人中的發生率約為 11 個，在台灣的發生率約佔小兒惡性腫瘤之 2.5% ，亦即每年約有 10~12 個新個案被發現，而其中 20% ~ 30% 為兩側性。

臨床症狀

本病最常見的症狀是出現白色瞳孔，看來像貓眼一樣，有時候病人照片發現兩邊瞳孔反射顏色不同。其次的是突然出現斜視，或是偶而可以看到眼球發炎、紅腫，若合併青光眼則會引起眼睛疼痛；至於視力的喪失，若只有單側...

【評論主題】6.臺灣地區已邁入老年社會，下列有關老人常見的良性攝護腺肥大所進行的經尿道攝護腺切除（TURP）之麻醉的考量，何者錯誤？(A)架腳（lithotomy）的姿勢會影響肺FRC（functional re

【評論內容】

Transurethral Resection of the Prostate (TURP) Syndrome is a rare but potentially life-threatening complication of a transurethral resection of the prostate procedure. 

It occurs as a consequence of the absorption into the prostatic venous sinuses of the fluids used to irrigate the bladder during the operation.[1] 

Symptoms and signs are varied and unpredictable, and result from fluid overload and disturbed electrolyte balance and hyponatraemia. 

The oncotic pressure of blood will decrease as a result of the dilution of serum proteins, and this coupled with hypertension will push fluid from th...

【評論主題】5.下列何者不影響最小肺泡濃度（minimum alveolar concentration）值？(A)高血壓(B)肌肉鬆弛拮抗劑(C)缺氧（PaO2 ＜ 40 mmHg）(D)使用reserpine

【評論內容】

影響MAC的因素a. 體溫：

體溫偏高(37~42度)時因為代謝變快，會使MAC下降，但若達42度以上時，會產生蛋白質壞死的現象，會使MAC上升

體溫過低，代謝變慢，使MAC下降b. 年紀：年輕人所需的MAC較高，老年人則下降c. 長期使用酒類會使MAC提高d. 懷孕會使MAC下降

Factors that INCREASE anesthetic requirements Factors that DECREASE anesthetic requirements

 

HypernatremiaHyponatremiaHyperthermiaHypothermiaInfancy (peaks at 6 mo)Elderly patientsChronic alcohol useAcute alcohol intoxicationAcute cocaine or amphetamine usePregnancy Anemia Hypoxemia CNS depressant drugs (opioids, benzos, TCAs)

The afferentation theory sta...

【評論主題】4.巴比妥類藥物，如thiopental，其主要作用機轉為何，使其可產生良好的鎮靜作用？(A)阻斷鈉離子通道（sodium channel blocker）(B)加強γ-aminobutyric ac

【評論內容】

Sodium thiopental is a member of the barbiturate class of drugs, which are relatively non-selective compounds that bind to an entire superfamily of ligand-gated ion channels, of which the GABA_{Areceptor channel is one of several representatives.}

【評論主題】【題組】51.承上題，最常施行上述檢查的妊娠週數為何？(A)11～14週(B)26～28週(C)31～13週(D)36～38週

【評論內容】

◎懷孕11~14周，建議自費1500~2000元，超音波檢測胎兒頸後透明帶（含母血抽驗），以篩檢唐氏症◎懷孕20~22周，國健局公務預算給付超音波檢測胎兒體重、胎盤位置、羊水量等◎懷孕26~30周，產婦可自費2000~3600元進行3D或4D超音波，了解胎兒輪廓，但非必要◎懷孕32~36周，建議以超音波檢測胎位、胎兒生長評估等，為生產做準備，現須自費800~1000元◎台灣婦產科醫學會建議國健局，新增懷孕32~36周的超音波檢查也以公務預算給付資料來源：徐明洸醫師、黃閔照醫師、台灣婦產科醫學會 

【評論主題】49 卵巢癌的分期手術，不包括下列何者？(A)腹膜切片 (B)網膜切除(C)骨盆及大動脈旁淋巴結切除 (D)子宮根治性切除

【評論內容】

這題真的考很細，注意我們staging只用total hysterectomy, 不用 radical hysterectomy。

Total extrafascial hysterectomy with bilateral salpingo-oophorectomy, pelvic and paraaortic lymph node dissection, and infracolic or infragastric omentectomy is the standard staging procedure for ovarian, fallopian tubal, and peritoneal carcinoma. Peritoneal cytology is collected after the incision is made. Staging also includes assessment of upper abdomen, peritoneal surfaces and large and small bowel mesentery with possible biopsies, and cytology of the diaphragm. Appendectomy may be indicated...

【評論主題】42 一位 23 歲年輕女性，因為青春痘及手腳多毛來求診，發現她的月經也很不規則，每年只有 2～3 次。抽血檢查發現她的 FSH 於正常值邊緣，但 LH 值卻很高，最可能的診斷為何？(A)testic

【評論內容】

Rotterdam criteria (preferred) — We use the 2003 Rotterdam criteria to make the diagnosis of PCOS. Two out of three of the following criteria are required to make the diagnosis [19]:

●Oligo- and/or anovulation

●Clinical and/or biochemical signs of hyperandrogenism

●Polycystic ovaries (by ultrasound)

Many women with irregular menses and hyperandrogenic symptoms can be diagnosed based upon on the history and physical exam alone. However, the diagnosis of PCOS is only confirmedwhen other conditions that mimic PCOS are excluded (eg, disorders that cause oligo/anovulationand/or hyperandrog...

【評論主題】38 一位 16 歲智能不足且無性經驗之女孩，長期有慢性便秘之情形，近日因下腹脹痛及小腹微凸而到院接受診察。經腹部超音波發現腹中有一水囊狀物（如下圖*處），位於子宮上面。子宮體之矢狀切面大小為 5×4

【評論內容】那個就是膀胱啊？！懷疑哦？

【評論主題】25.下列何者為最易造成胎盤早期剝離（placental abruption）的原因？(A)高血壓（hypertension）(B)子宮肌瘤（leiomyoma）(C)血栓形成（thrombophil

【評論內容】

Hypertensive women have a five-fold increased risk of severe abruption compared to normotensive women, and antihypertensive therapy does not appear to reduce the risk of placental abruption among women with chronic hypertension [42]. Vitamin C-E supplementation appeared to mitigate the risk of abruption among smokers in one study [43], but this finding must be cautiously interpreted given the small number of events and wide confidence interval.

【評論主題】27.2天大的足月新生兒，接受例行性的血氧篩檢時發現雙側下肢的血氧飽和度是90%，右手血氧飽和度是98%， 最有可能是下列那一種先天性心臟病？ (A)完全型動脈幹（Complete truncus a

【評論內容】

https://www.youtube.com/watch?v=1ZFaal1K8OQ

【評論主題】19.有關聽神經瘤（acoustic neuroma）的臨床敘述，下列何者錯誤？(A)比較正確的名稱應為前庭神經鞘瘤、許旺氏細胞瘤（vestibular schwannoma）(B)最常見的臨床症狀是

【評論內容】Facial nerve palsy要想parotid tumor, tumors in temporal bone, like CN7 neuroma, meningioma, hemangioma, Malignant primary and metastatic lesions

【評論主題】6.下列何者是治療麻醉氣體引起的惡性高溫（malignant hyperthermia）最主要的藥物？(A)propranolol(B)dantrolene(C)doxazosin(D)nifedip

【評論內容】

惡性高熱較好發於男性，男女的比例約是2:1，目前已知至少有6個基因與惡性高熱有關。雖然惡性高熱是顯性遺傳，但患者於日常生活中完全不受影響，必須遇上特定因子才會被觸發，使鈣離子源源不絕地流進到肌肉細胞內，導致惡性高熱。最常見的觸發因子是用於全身麻醉的麻醉性氣體及去極化肌肉鬆弛劑。

倘若遇上不曉得自己帶有惡性高熱，而在麻醉過程中發作的患者要立刻關掉觸發藥物，並施打目前唯一的解藥「單挫林（Dantrolene）」。

然而大家可能不曉得，台灣大多數的醫院連1支單挫林都沒有。從麻醉醫學會網站上公布的庫存清單中可以發現台灣470餘間醫院中僅有20餘間醫院備有單挫林。小型地區醫院也就罷了，可是規模大、手術量多的區域醫院中備有單挫林的醫院竟然也屈指可數，甚至連部分醫學中心都沒有準備單挫林。

【評論主題】4.下列何者不是脫離呼吸器（weaning from ventilator）的條件？(A)呼吸速率 < 25 / minute(B)動脈血氧氣分壓（ PaO2）＞ 70 mmHg（FiO240%

【評論內容】Parameter Normal Adult Range Weaning Threshold Utility Rate/Tidal Volume < 50/min/L <105/min/L High (+/-) Max Inspiratory Pressure -90 cm (F); – 120 (M) – 25 cm H2O High (- only) PaO2/FiO2 400 200 unknown Tidal Volume 5 – 7 mL/kg 5 mL/kg unknown Respiratory Rate 14 – 18 < 40 unknown Vital Capacity 65 – 75 mL/kg 10 mL/kg unknown Minute Ventilation 5 – 7 L/min < 10 L/min Very Poor (~ 50%)

【評論主題】3.下列何者不是器官移植之後使用的抗排斥藥物？(A)basiliximab(B)rabbit antithymocyte globulin(C)tacrolimus(D)valacyclovir

【評論內容】

疱疹感染無法醫治，因為疱疹病毒已進入神經，潛伏在神經根，強力的抗疱疹藥物acyclovir（Zovirax）、famciclovir（Famvir）、以及valacyclovir (Valtrex)可防止大多數的爆發，但並沒有消除隱藏在神經細胞中的病毒

---[WebMD]疱疹藥物無法阻止疱疹散播@ 快樂小藥師Im pharmacist nichts

看看故事;

在1985 年，第一個單株抗體，OKT3，開始應用在臨床上作為抗排斥治療的引導劑以及用來治療急性排斥，到1990 年代，很多醫學中心的腎臟移植一年存活率已經可以達到90%。1990 年代早期，tacrolimus 開始被使用在器官移植上而得到可以和cyclosporine 比擬的移植器官以及病人的存活率。接下來mycophenolate mofetil 也被發現在同時伴隨cyclosporine 及類固醇使用的情況下， 比azathoprine 更能有效降低急性排斥的發生率。

--免疫抑制劑, 李志元 蔡孟昆

【評論主題】2.外傷病人使用各種輸液及血液製品來復甦急救，其目的在於使人體各個組織都能得到充足組織灌流（tissueperfusion）。尿液的排出量為一客觀實用之定量指標，則下列何者為正確指標？(A)成人大於1

【評論內容】

The normal range for 24-hour urine volume is 800 to 2000 milliliters per day (with a normal fluid intake of about 2 liters per day).

Oliguria is urine output < 500 mL in 24 h (0.5 mL/kg/h) in an adult.Oliguria is urine output < 1 L in 24 h (1 mL/kg/h) in a child.

One definition (RIFLE consensus definition of the Acute Dialysis Quality Initiative) of risk of AKI being <0.5 cc/kg/hr for 6+ hours, injury of AKI if <0.5 cc/kg/hr for 12+ hours, and failure if <0.3 cc/kg/hr for 24+ hours (or anuric for 12 hours)...

【評論主題】18.50歲男性主訴左耳反覆耳漏及聽力損失超過10年，局部檢查後，安排高解析度電腦斷層攝影，結果如下：在上鼓室有一軟組織包圍聽小骨（如下圖），最有可能之診斷為何？ (A)積液性中耳炎(B)乳突炎(C)

【評論內容】一名35歲的女性多年來左耳不斷反覆流膿，一直以為是中耳炎，但直到出現臉皮脹痛、眼皮睜不開、嘴巴歪斜並且有暈眩的情況，再作檢查才發現是中耳膽脂瘤惹的禍；膽脂瘤會侵襲骨頭，嚴重時恐破壞聽小骨、三半規管、顏面神經，更嚴重時恐侵襲顱底骨，恐導致腦膜炎，造成生命危險；提醒如果中耳炎藥物治療2周後未改善，應及早就醫處理。收治這名女性的萬芳醫院耳鼻喉科主治醫師曾智傑表示，膽脂瘤和中耳炎一樣，都容易有流水、流膿、耳朵悶塞感，因此常常只被當作中耳炎復發處理；膽脂瘤是反覆中耳炎，角質堆積產生的發炎物質導致的疾病，發炎物質會侵蝕骨頭，嚴重時恐破壞聽小骨、三半規管、顏面神經；這名女士主管面部表情的顏面神經和主管平衡的三...

【評論主題】17.40歲的女性病患主訴反覆眩暈發作數年，病史中得知每次發作都有懼光（photophobia）或懼音（phonophobia），且常常發作都與月經期有關。當食用乳製品（dairy products如

【評論內容】http://www.neuropt.org/docs/vsig-english-pt-fact-sheets/migraine-diet-triggers.pdfThe list of foods that have been reported to cause migraine symptoms is quite long. But the most common foods are MSG (monosodium glutamate), aged cheese, red wine and beer, and chocolate. These foods contain substances called amines that are thought to trigger migraine symptoms in some people. There are many websites that provide lists of foods containing the different amines in great detail. The more common foods that have been identified as triggering a migraine may be summarized as follows:Cheeses that are...

【評論主題】3.36歲有抽菸男性，因胸痛來到急診，胸痛已有八個小時，會傳向雙側上臂，且胸痛會因吸氣而加重，躺下時更嚴重，在坐起時上半身略向前傾會好一些。身體診察血壓140/72毫米汞柱，心跳每分鐘96次，沒用氧氣

【評論內容】CHEST PAIN

MI 與 pericarditis 區分

Unlike pain from myocardial ischemia, chest pain due to pericarditis is most often sharp and pleuritic in nature, with exacerbation by inspiration or coughing. One of the most distinctive features is the tendency for a decrease in intensity when the patient sits up and leans forward.

This position (seated, leaning forward) tends to reduce pressure on the parietal pericardium, particularly with inspiration, and may also allow for splinting of the diaphragm.

Radiation of chest pain to the trapezius ridge has also been considered to be fairly specific for pericardi...

【評論主題】14.散光鏡片度數的記載＋2.0D sphere with cylinder -3.0D axis 90°與下列何者是相當的？(A)-2.0D sphere with cylinder＋3.0D ax

【評論內容】

It is hard to explain by writing, I hope this will help.

【評論主題】6.一位病人發現其小便像濃茶，至醫院就醫時，醫師也在身體診察中確認其皮膚及鞏膜有泛黃現象，小便檢驗發現bilirubin（3+）。下列各項檢查或檢驗，何者最不具診斷效益？(A)腹部超音波檢查(B)抽血

【評論內容】

For clinical purposes, serum bilirubin is fractionated to classify hyperbilirubinemia into one of two major categories

●Plasma elevation of predominantly unconjugated (indirect) bilirubin. This may be due to the overproduction of bilirubin, impaired bilirubin uptake by the liver, or abnormalities of bilirubin conjugation (algorithm 1).

●Plasma elevation of both unconjugated and conjugated (direct) bilirubin. This may be due to hepatocellular disease, impaired canalicular excretion of bilirubin, or biliary obstruction (algorithm 2). This is often referred to as conjugated hyperbilirubinemia, ev...

【評論主題】1.下列與腹部腔室症候群（abdominal compartment syndrome）相關的症狀，何者錯誤？(A)腹內壓突然增加(B)小便量減少(C)缺氧（hypoxia）(D)血壓正常

【評論內容】

一般人在自然呼吸時所量測的腹內壓力為0mmHg，在重病患者腹內壓力會增加至4-10mmHg。定義上，若量測得的腹內壓力持續大於10mmHg 稱為腹內高壓(IAH)，若合併器官受損稱為腹部腔室症候群(ACS)。

s/s

小便減少、膚唇發紺、呼吸喘、快、費力、血氧濃度下降的情況，腹部檢查呈現脹大而僵硬的腹部，皮膚出現「大理石斑紋」樣的暗青花斑。

【評論主題】2.全身麻醉期間使用氣管內管（endotracheal tube），應以壓力計測量其cuff pressure，並應保持下列何者合理壓力，以預防病人吸入胃液與附近組織缺血？(A)18 cmH2O(B)

【評論內容】

可見其安全的壓力在20~30 cmH2O之間

【評論主題】2.90歲的林奶奶患有血管性的失智症，近日來日夜顛倒，晚上無法睡覺，常常想要開門出去，外勞有時都拉不住，家人感到非常無助，來到門診尋求幫忙。下列有關失智症的敘述，何者正確？(A)血管性的失智症是最常見

【評論內容】

(A) 理論上對

和西方國家相同，台灣的失智症社區研究發現阿茲海默氏病是當中最常見的類型 。但是兩起醫院的調查卻發現醫院中求診的病患，血管性失智症的比例高於阿茲海默氏病 。

社區調查和醫院調查不同的原因目前仍不清楚，可能是社區研究沒有將每位診斷為失智症的病患都進行影像檢查，因此低估了血管性失智症的盛行率。另外，也可能是血管性失智症死亡率較高，也因合併有其他疾病如高血壓、糖尿病等，而求醫機會較高。

失智症之類型在社區中，以阿爾滋海默氏病(Alzheimer'5 disease, AD)為主，約佔半數；其次為血管型失智症（Vascular dementia, VaD約20～25%）及混合型失智症（約5-10%）。

ref: Liu HC, tsou HK, Lin KN, et al:Evaluation of ...

【評論主題】1.一位病人血液氣體分析顯示pH 7.51，PaCO249 mmHg，HCO3- 38 mmol/L，下列何者正確？(A)代謝性酸中毒（酸血症）(B)代謝性鹼中毒(C)呼吸性酸中毒(D)呼吸性鹼中毒

【評論內容】

pH正常值:7.35~7.45

此人偏鹼 (Alkalosis)PaO2 正常值:80-100mmHgpaCO2 正常值:35~45  mmHgHCO3- 正常值 : 22-26 meq / L此人CO2高、HCO3-高PaCO2上升：可能是resp. acidosisHCO3–上升：可能是met. alkalosis判讀時要注意primary disorder，也就是先看pH值。現在pH值是鹼性，所以呼吸造成的酸要當成代償。原發是一個代謝性的鹼中毒。再來要看代償成功與否。要代公式：Met. alkalosis：ΔPaCO2 = 0.7 * ΔHCO3–代償正常的ΔPaCO2 = 0.7 x 14 = 9.8此病人的ΔPaCO2 = 9ΔPaCO2比預期的還要低，可以算是合併resp. alkalosis，也就是他代償不過來了。--------------------------以下補充公式：Met. acidosis：ΔPaCO2 = 1.2 * ΔHCO3–Met. a...

【評論主題】76.下列何者為使用rapid sequence intubation（RSI）的禁忌？(A)躁動(B)癲癇發作(C)藥物過量(D)嚴重臉部外傷

【評論內容】Contraindications of RSIAbsolute

Total upper airway obstruction, which requires a surgical airway

Total loss of facial/oropharyngeal landmarks, which requires a surgical airway

Relative

Anticipated "difficult" airway, in which endotracheal intubation may be unsuccessful, resulting in reliance on successful bag-valve-mask (BVM) ventilation to keep an unconscious patient alive

In this scenario, techniques for awake intubation and difficult airway adjuncts can be used.

Multiple methods can be used to evaluate the airway and the risk of difficult intubation (eg, LEMON rule, 3-3-2, Mallampati class, McCo...

【評論主題】61.下一列那一條韌帶在踝關節扭傷發生率最高？(A)三角韌帶（deltoid ligament）(B)前脛腓骨韌帶（anterior tibiofibular ligament）(C)後距腓骨韌帶（p

【評論內容】

Lateral ankle sprain — The most common mechanism of ankle injury is inversion of the plantar-flexed foot (figure 2), which causes damage to the lateral ligament complex of the ankle. This ligament complex consists of the anterior talofibular ligament, the calcaneofibular ligament, and the posterior talofibular ligament (figure 3). The ligaments within this complex are injured in a predictable sequence as forces increase.

The anterior talofibular ligament is the first or only ligament to be injured in the majority of ankle sprains. Stronger forces lead to combined ruptures of the anterior tal...

【評論主題】50.有關排卵藥clomiphene citrate敘述，下列何者錯誤？(A)主要可以治療促性腺激素低下型低性腺功能症（hypogonadotropic hypogonadism WHO group

【評論內容】

由於hypogonadotropic hypogonadism 是本身無法分泌FSH與LH，因此抑制雌激素的副回饋仍然無法解決問題。須解決其根本因素，如： brain or pituitary tumors, pituitary apoplexy, head trauma, ingestion of certain drugs, and certain systemic diseases and syndromes.

Mechanism of Action  (clomiphene)

Clomiphene is a racemic mixture consisting of zuclomiphene (~38%) and enclomiphene (~62%), each with distinct pharmacologic properties. Clomiphene acts at the level of the hypothalamus, occupying cell surface and intracellular estrogen receptors (ERs) for longer durations than estrogen. This interferes with rece...

【評論主題】60.骨折手術後，下列那一種運動最能避免骨關節受到不恰當的受力？(A)等長性收縮（isometric contraction）(B)向心性等張式收縮（concentric isotonic contr

【評論內容】

【評論主題】55.下列何種指標最不常用於臨床上評估腦傷（traumatic brain injury）病人的預後？(A)腦傷後癲癇（seizure）的發生頻率(B)昏迷（duration of coma）時間的長

【評論內容】

PROGNOSIS — Outcome from severe head injury is dependent on a range of factors including baseline patient characteristics, severity of TBI, and the occurrence of medical complications and secondary brain insults. Specific negative outcome predictors that have been identified from these factors include [16,19-21,50,73,154,181-190]:

●Glasgow Coma Scale (GCS) score at presentation (especially the GCS motor score) (table 1)

●Full Outline of Unresponsiveness (FOUR) score (table 2)

●Presence and severity of computed tomography (CT) abnormalities (subarachnoid hemorrhage, cisternal effacement, mid...

【評論主題】42.依照International Continence Society所提出Pelvic Organ Prolapse Quantification system（POP-Q）不同部位缺陷之定量測

【評論內容】

POPQ measurements — Each point is located by measuring along the vaginal wall or identifying the most dependent point of a prolapsed structure. The measurement is then taken of the distance from the point to the hymenal plane. The anatomic location of each point is (figure 1) [20,21]:

●Anterior vaginal wall points:

•Point Aa is located in the midline of the anterior vaginal wall, 3 cm proximal to the external urethral meatus, corresponding approximately to the urethrovesical junction. The quantitative value of point Aa is anywhere from –3 to +3 cm from the hymenal plane, depending upon t...

【評論主題】27.30歲孕婦，妊娠42週，欲予引產，根據Bishop score評分其子宮頸成熟度，若子宮頸閉合，Effacement 10%，Station：-3，子宮頸硬度為堅硬（firm），並且子宮頸位於後

【評論內容】

A Bishop score ≥8 suggests the chances of having a vaginal delivery are good and the cervix is considered favorable or ripe for induction. If the Bishop score is low, variably defined as ≤3 to 6, the chances of having a vaginal delivery are lower, and the cervix is considered unfavorable or unripe for induction. A simplified Bishop score can be calculated using only dilation, station, and effacement. Using these three variables, a simplified Bishop score ≥5 has a similar predictive value for vaginal delivery as a classic Bishop score ≥8.

子宮頸閉合: 0

Effacement 10%: 0 

Station：-3...

【評論主題】9.下列關於視網膜胚細胞瘤（retinoblastoma）之敘述，何者錯誤？(A)是小兒最常見的眼內原發惡性腫瘤(B)最常出現的症狀為白色瞳孔（leukocoria）(C)與致病相關之基因（RB1）位

【評論內容】

眼球結構由鞏膜、脈胳膜及視網膜包成一個球體，內部充滿膠質，叫做玻璃體，正前方則是水晶體，視網膜母細胞瘤是從視網膜長出來的一種惡性腫瘤. 這種腫瘤比較罕見，應該是出生的時候已存在，只是在出生時未被發現，大約 80% 在 1 歲或 2 歲左右被診斷出來。在美國 5 歲以下的兒童每 100 萬人中的發生率約為 11 個，在台灣的發生率約佔小兒惡性腫瘤之 2.5% ，亦即每年約有 10~12 個新個案被發現，而其中 20% ~ 30% 為兩側性。

臨床症狀

本病最常見的症狀是出現白色瞳孔，看來像貓眼一樣，有時候病人照片發現兩邊瞳孔反射顏色不同。其次的是突然出現斜視，或是偶而可以看到眼球發炎、紅腫，若合併青光眼則會引起眼睛疼痛；至於視力的喪失，若只有單側...

【評論主題】3.下列那些麻醉相關監視器對靜脈空氣栓塞（venous air embolism）偵測之敏感度（sensitivity），由高至低排列順序為何？①capnometer ②precordial dopp

【評論內容】

Transesophageal echocardiography (TEE) and precordial Doppler ultrasound were the most sensitive monitoring methods detecting 0.19 and 0.24 ml X kg-1 of air, respectively. TEE detected air during six infusions in which the Doppler failed to do so. 

Transesophageal echocardiography and transcutaneous O2 and CO2 monitoring for detection of venous air embolism.Glenski JA, Cucchiara RF, Michenfelder JD.Abstract

The sensitivities of current monitoring methods for detection of air embolism were compared in eight anesthetized dogs. Air was infused at controlled rates of 0.001 and 0.005 ml X kg-1 X m...

【評論主題】6.臺灣地區已邁入老年社會，下列有關老人常見的良性攝護腺肥大所進行的經尿道攝護腺切除（TURP）之麻醉的考量，何者錯誤？(A)架腳（lithotomy）的姿勢會影響肺FRC（functional re

【評論內容】

Transurethral Resection of the Prostate (TURP) Syndrome is a rare but potentially life-threatening complication of a transurethral resection of the prostate procedure. 

It occurs as a consequence of the absorption into the prostatic venous sinuses of the fluids used to irrigate the bladder during the operation.[1] 

Symptoms and signs are varied and unpredictable, and result from fluid overload and disturbed electrolyte balance and hyponatraemia. 

The oncotic pressure of blood will decrease as a result of the dilution of serum proteins, and this coupled with hypertension will push fluid from th...

【評論主題】2.麻醉藥物的效應可以大致分為催眠（hypnotic）以及止痛（analgesic）兩大方面來獨立考量，前者是麻醉深度監測（monitoring of the depth of anesthesia）

【評論內容】Patient physiology on intraoperative awareness

Very rare causes of awareness include drug tolerance, or a tolerance induced by the interaction of other drugs. Some patients may be more resistant to the effects of anesthetics than others; factors such as younger age, obesity, tobacco smoking, or long-term use of certain drugs (alcohol, opiates, or amphetamines) may increase the anesthetic dose needed to produce unconsciousness but this is often used as an excuse for poor technique.[citation needed] There may be genetic variations that cause differences in how quickly patients clear anesthet...

【評論主題】5.下列何者不影響最小肺泡濃度（minimum alveolar concentration）值？(A)高血壓(B)肌肉鬆弛拮抗劑(C)缺氧（PaO2 ＜ 40 mmHg）(D)使用reserpine

【評論內容】

影響MAC的因素a. 體溫：

體溫偏高(37~42度)時因為代謝變快，會使MAC下降，但若達42度以上時，會產生蛋白質壞死的現象，會使MAC上升

體溫過低，代謝變慢，使MAC下降b. 年紀：年輕人所需的MAC較高，老年人則下降c. 長期使用酒類會使MAC提高d. 懷孕會使MAC下降

Factors that INCREASE anesthetic requirements Factors that DECREASE anesthetic requirements

 

HypernatremiaHyponatremiaHyperthermiaHypothermiaInfancy (peaks at 6 mo)Elderly patientsChronic alcohol useAcute alcohol intoxicationAcute cocaine or amphetamine usePregnancy Anemia Hypoxemia CNS depressant drugs (opioids, benzos, TCAs)

The afferentation theory sta...

【評論主題】4.巴比妥類藥物，如thiopental，其主要作用機轉為何，使其可產生良好的鎮靜作用？(A)阻斷鈉離子通道（sodium channel blocker）(B)加強γ-aminobutyric ac

【評論內容】

Sodium thiopental is a member of the barbiturate class of drugs, which are relatively non-selective compounds that bind to an entire superfamily of ligand-gated ion channels, of which the GABA_{Areceptor channel is one of several representatives.}

【評論主題】1.呼吸道處置上潛在性的困難，下列何者的關係性最為薄弱？(A)舌前緣的病灶（lesions at the anterior margin of the tongue）(B)新近發生的聲音沙啞（rece

【評論內容】呼吸道評估

(1) 病史

過往插管紀錄，口腔及呼吸道腫瘤，口腔內部感染，頸部疾病，肥胖，硬皮症，皮膚燒燙傷(會有fibrosis)等

(2) 理學檢查

要特別注意牙齒有沒有鬆動！不然插管時可能會掉Difficult intubation的狀況：LEMON

(3) LEMON

Look externally短下巴、短脖子、肥胖、牙齒晃搖等

Evaluation3-3-23：張口是否有達到3個指幅3：下巴前緣到舌骨是否達到3個指幅2：舌骨到甲狀軟骨是否達到2個指幅

Mallampati分級根據舌根影響看聲門程度作分級患者須坐直，將嘴巴開到最大，並將舌頭吐出(a) I級：可以看到懸壅垂、軟顎、兩側的咽弓(b) II級：可以看到軟顎、兩側的咽弓；但是懸壅垂被舌根蓋到(c) III級：只能看到軟顎；懸壅垂和兩側的咽弓都被舌根擋住了(d...

【評論主題】40歲孕婦，G3P2，妊娠22週，接受檢查，結果如圖所示，【題組】51.則檢查之胎兒部位名稱為何？(A)abdomen(B)chest(C)head(D)neck

【評論內容】

胎兒頭部的超音波主要是分三個平面

1. thalamic view 

2. ventricular view

3. cerebellar view

上圖為標準的ventricular view。其實小弟也不是很會看超音波，猜這個應該是ventricular view吧。

大家可以去OB image看看 (https://www.obimages.net/normal-cns-ultrasound-anatomy-brain/)

【評論主題】【題組】50.承上題，正在縫合的組織為何？(A)vaginal mucosa(B)vaginal submucosa(C)anal sphincter(D)rectal mucosa

【評論內容】Repair of a fourth-degree obstetric lacerationA. 4th degree laceration B. The torn anal mucosa is repaired using a running stitch, but interrupted stitches are also acceptable. C. The internal anal sphincter should be properly identified and repaired as a separate layer. D. The external sphincter is then identified and repaired. The repair consists of either end-to-end or overlapping plication of the disrupted external anal sphincter and capsule using interrupted or figure-of-eight sutures...

【評論主題】37歲孕婦，G1P0，妊娠39週，生產後如圖所示：【題組】49.下列四者中最可能的診斷為何？(A)first-degree laceration(B)second-degree laceration(

【評論內容】

第一度: 破到表皮

第二度: 破到肌肉

第三度: 破到肛門括約肌

第四度: 破到直腸

【評論主題】【題組】48.承上題，S/D ratio為 2.5，檢查結果為何？(A)absent end diastolic velocity(B)reversed end diastolic velocity(

【評論內容】

An S/D ratio 3.0 or RI 0.6 at ≥28 weeks of gestation is the best threshold for identifying pregnancies at high risk of adverse outcome 

【評論主題】44.下列何者不適合接受人類乳突病毒疫苗？(A)25歲曾有5個性伴侶上班族(B)12歲未有性經驗國小女生(C)46歲子宮頸癌患者(D)23歲抹片曾有輕度子宮頸上皮內贅瘤（CIN 1）研究生

【評論內容】

理論上沒啥限制，只是國外研究只做到26歲罷了。(小弟淺見，歡迎其他同學指教)

The main reason that routine catch-up HPV vaccination is not recommended for individuals older than 26 years is the increased likelihood of prior exposure to HPV vaccine types with age, which reduces the potential individual benefit and thus the cost-effectiveness of HPV vaccination. However, for some individuals in this age group, such as those with no prior sexual experience or certain lifelong sexual monogamy, the risk of prior HPV exposure may be very low. We offer HPV vaccination to such individuals, as it may be bene...

【評論主題】42.在已開發國家大多數的子宮內膜癌診斷時，都是第幾期？(A)第一期(B)第二期(C)第三期(D)第四期

【評論內容】

47%發現者在第一期

子宮內膜癌真的這麼可怕嗎？其實不然。總體而言，子宮內膜癌是一種治療效果很好的婦科惡性腫瘤。在美國和其它西方發達國家，子宮內膜癌已經成為最常見的婦科惡性腫瘤，但它卻不是引起婦女死亡最常見的婦科惡性腫瘤。根本原因在於，絕大多數子宮內膜癌在診斷時都是早期病變！

早期子宮內膜癌的治療效果很好，5年存活率達97-99%，絕大多數患者長期存活，預期壽命不受影響。甚至有研究認為，由於子宮內膜常常與肥胖、高血壓、糖尿病等疾病相伴發生，因診斷子宮內膜癌並得到治療後，患者多會改變生活方式，結果死於伴發疾病的機會更低。儘管如此，晚期子宮內膜的治療效果仍然很差...

【評論主題】41.48歲婦女，做抹片檢查，報告為high-grade squamous intraepithelial lesion（HSIL），下一步處置何者最適當？(A)半年抹片追蹤一次(B)考慮HPV檢查並

【評論內容】

細胞學檢查可能出現的結果

1.未見上皮內病變細胞或惡性細胞（NILM）

◆意思是：宮頸細胞正常，不需要做特殊的處理。

2.黴菌感染、滴蟲感染、放線菌感染

◆意思是：陰道正常菌群失調，或者是有滴蟲等病原微生物侵入導致有感染。

◆處理：醫生可能會建議做一個白帶常規和細菌性陰道病檢查，根據檢查結果做相應治療。

3.ASC-US

◆意思是：非典型意義的磷狀細胞或不能明確意義的不典型磷狀細胞。這個結果提示不確定這些細胞是否存在異常。

◆處理：建議半年後複查細胞學或做「HPV檢查」。

4.ASC-H

◆意思是：非典型磷狀細胞不排除高度磷狀上皮內病變。即不明確意義，但傾向於有病變。

◆處理：建議做「HPV檢查」，行陰道鏡+宮頸活檢。

5.LSIL

◆意思是：低度磷狀上...

【評論主題】40. 先天性腎上腺增生症（congenital adrenal hyperplasia, CAH）的遺傳模式為：(A)體染色體顯性遺傳(B)體染色體隱性遺傳(C)性聯遺傳(D)性染色體異常

【評論內容】

先天性腎上腺皮質增生症 (congenitaladrenal hyperplasia，CAH)

 該疾病為一組染色體隱性遺傳病，其發病率為1/10 000 ~ 1/20 000，在不同地區和種族間具有差異性。臨床上較少見，且酶的缺陷不同，臨床表現各異。

失鹽型：21- 羥化酶完全缺乏，出生後即可有脫水、拒食、嘔吐、腹瀉、低血鈉、高血鉀等症狀。

單純男性化型：由於 21- 羥化酶不完全缺乏，可少量合成皮質醇和醛固酮，常不伴電解質紊亂，主要表現為雄激素增多和外生殖器發育異常。女性出現假兩性畸形，如陰蒂肥大、大陰唇似陰囊等男性化體徵。男性則表現為假性性早熟...

【評論主題】37.58歲婦女，停經2年，無婦科開刀病史，無熱潮紅，心悸症狀，但會有陰部乾澀，性交疼痛的困擾，其最適當的治療為：(A)口服大豆異黃酮(B)口服雌激素與黃體素(C)口服雌激素(D)陰部雌激素局部使用

【評論內容】

目前，經陰道用雌激素正被廣泛應用於婦女，對陰道乾澀、性交疼痛以及萎縮性陰道炎等泌尿生殖道萎縮症狀效果好，可逆轉陰道組織的萎縮性改變，緩解相關症狀，同時限制全身性吸收。作為女性特有的給藥方法，經陰道用雌激素避免了肝臟首過效應，可持續給藥，全身不良反應小，無胃腸道刺激，不需要每月加孕激素，很少發生陰道流血。在患者年齡很大時仍可陰道局部用藥，而無需考慮全身不良反應。缺點是藥物吸收不穩定，使用不方便。

【評論主題】35.34歲婦女，不孕症5年，經檢查發現雙側輸卵管水腫（hydrosalpinx），卵巢功能正常，先生精液檢查正常，下一步應建議她做何治療？(A)人工授精(B)打排卵針增加懷孕機會(C)吃排卵藥增加懷

【評論內容】

對輕度的輸卵管積水，年輕、卵巢儲備功能正常、不孕年限短、男方精液正常的患者推薦腹腔鏡輸卵管整形或造口術，術後可以嘗試自然受孕，術後宮內妊娠機率是58-77%、宮外孕機率是2-8%。如果手術後一年仍未能懷孕，則建議體外受精-胚胎移植(IVF-ET)。

【評論主題】34.子宮輸卵管攝影（hysterosalpingography）是用來評估女性不孕症的一項檢查，下列檢查日期何者最好？(A)月經週期第3天(B)月經週期第8天(C)月經週期第14天(D)月經週期第2

【評論內容】

子宮輸卵管造影（HSG）是指將造影注入子宮腔內，通過X-線觀察記錄造影劑的流動的過程，顯示子宮、輸卵管內腔的形態，以及造影劑流入腹腔後的瀰散情況，從而對子宮輸卵管形態功能做出診斷的不孕症檢查措施。HSG是女性不孕症的初始檢查之一，具有不可或缺的診斷價值。

一般HSG檢查選擇的時間在月經乾淨以後第3天到第7天，對於月經不規律的病人可以延遲到10天，特別不規律比如說閉經的病人可以隨時做，但需排除妊娠的可能。做檢查前應當確認沒有婦科炎症及白帶異常，檢查的當天早晨建議不要空腹，以免出現術後低血糖症狀。

HSG適應症包括了：能有正常排卵，生殖內分泌無異常，男方精液檢查無異常,但一直不能懷孕者；曾有盆腔炎，闌尾炎，陰道炎等炎症...

【評論主題】32.40歲已婚性，因子宮內膜息肉接受子宮鏡手術，子宮鏡使用單極電燒（monopolar）。手術時畫面清晰良好但發現電燒無法作用，經流動護士檢查電燒機功能正常，且電源接觸良好，下列何種子宮腔擴張介質

【評論內容】

Isotonic electrolyte-containing solutions cannot be used with monopolar energy because this leads to activation of ions that disperse the electric current and reduce the power density. 

【評論主題】31.慢性骨盆腔疼痛的鑑別診斷中Mittelschmerz表示：(A)痛經(B)排卵痛(C)發炎痛(D)痔瘡痛

【評論內容】

經間痛（排卵痛）：月經週期中間出現的腹痛，是排卵的信號。在排卵期，卵巢排出卵子和一些液體、血液，這些排出物刺激腹部粘膜從而引發疼痛。經間痛（Mittelschmerz）來自德語，意思是「中間」和「疼痛」的意思。經間痛是人體一種正常反應，通常會持續幾個小時。