【NAlexE】點評問題和點評內容

用戶【NAlexE】點評問題和點評內容

【評論主題】67 △H°and△S° for the vaporization of Br2(I) at 25°C and 1 atm are 30.8 kJ\\/mol and 92.8 J\\/K-mol,

【評論內容】偷吃步：要找Temperature，題目有給單位，湊到 Temperature到分子k可能想混淆單位視聽，要注意QQ，308000 J/mol / 92.8 J/K*mol = 332 K

【評論主題】50.For a car traveling with speed v around a curve of radius r, determine a formula fbr the angle θ,

【評論內容】神猛，無敵超級賽車手，在傾斜的跑道上急速迴轉

【評論主題】20.The point group of H2O2 is_______ . (A) C2 (B) C2v (C) C3 (D) C3v(E) none of the above

【評論內容】原詳解打在 112中山，直接把它移動過來...

【評論主題】29.70歲男性，因高血壓、心衰竭，長期服用下列藥品，入院時心電圖顯示為first-degree AV block，最可能與其所服用的那些藥品有關？①amlodipine 5 mg QD ②digox

【評論內容】29.70歲男性，因高血壓、心衰竭，長...

【評論主題】28.ST-segment elevation myocardial infarction（STEMI）發作，且無法於120分鐘內進行PCI時，最適合採用下列何者治療？ (A)alteplase (B

【評論內容】28.ST-segment eleva☆☆☆☆ ...

【評論主題】76. Which of the followings describes the initial bond formation in the covalent intermediate in the

【評論內容】

Chymotrypsin 剪 Tyr Y, Trp W, Phe F, (Leu, L)Oxyanion hole 放置O-結構的地方Hydrophobic pocket 給被切的胺基酸放置親酯性基團的位置 (受質都是親酯性A.a.)1. Serine 195 和 His 57 Imidazole基團的交互作用使得Serine的-OH上產生一個醇鹽基對親脂性A.a.的 C端進行親核性攻擊形成一個 tetrahedral acyl-enzyme 2. 接著受質(中間物)出現一個短暫的O-，由 Serine 195 和 Glycine 193 形成氫鍵穩定在Oxyanion pocket中(注意此時Serine以酯鍵和C端連結)3. 但胺基酸上的O-仍很不安定，因此和連結自己的碳形成雙鍵，該碳隨即因此和隔壁 A.a. N端斷開連結離去的胺基酸基團 (右邊藍色者)，則由 His 57補上一個 H (紅色) 促進離開。4. H2O 進入結構，被Histone的 Imidazole基搶走H形成了一個強親核OH-基，進行了跟先前Serine-OH 相似的反應機構使得胺基酸的C端氧再次攜帶負電並待在Oxyanion pocket中結構再次因為O-不安定而解開，創造出羧酸鹽(carboxylate)和Serine的OH基最後就恢復成最上面的Chymotrypsin啦R1. 通常 Serine pKa 在正常生理pH不會解離但是感謝Ser 195, His 57, Asp 102形成的催化三角 (catalytic triad)當一個Peptide進來時會擠壓His跟Asp之間的氫鍵，形成Low-Barrier Hydrogen Bond，導致之間引力更強，也使得His的pKa自7 上升到>12讓Histidine有辦法作為一個General base來拿走Serine上面的H，使其成為強親核基(所以才會攻擊人家)圖片可以參照Lehninger 8e，我是照著上面流程翻譯的...(本來有放圖片，但我怕被版權幹掉QQ)

76. Which of the following describes the initial bond formation in the covalent intermediate in the reaction catalyzed by chymotrypsin?

【評論主題】27. Which of the following sets of amino acids are directly involved in the biosynthesis of creatine

【評論內容】

Glutathione - GCE (Glycine Cyestine Glutamate)Creatine - RG (M) Arginine, Glycine, MethionineEpinephrine/Dopamine/Norepinephrine/Melanin - YF Tyrosine, PhenylalanineMelatonin/Serotonin - W, TryptophanGABA - Q, GlutamineHistamine - H, Histone鹼基(Base)Pyrimidine - D Aspartate N1, C4, C5, C6; Q Glutamine N3;Purine - D Aspartate N1; Q Glutamine N3, N9; G Glycine C4, C5, N7;

【評論主題】22 下列 HMG-CoA inhibitors 藥品中，那一個在人體內的血漿中半衰期 (plasma half-life) 最長？(A)Lovastatin(B)Simvastatin(C)Fluv

【評論內容】根據課本描述 Basic & C☆☆☆☆☆☆☆...

【評論主題】1. The presidential candidate involved in the corruption scandal is struggling to salvage hisreputat

【評論內容】1. The presidential candidate involved in the corruption scandal is struggling to salvage his reputation.

【評論主題】4.Which of the following amino acid substitutions would be least likely to have a detrimental effect

【評論內容】4.Which of the following amino acid substitutions would be least likely to have a detrimental effect on protein folding and function?

【評論主題】7.His_______for detail leads him to examine the report multiple times for possibleinconsistencies.(A

【評論內容】7.His_______for detail leads him to examine the report multiple times for possible inconsistencies. (不一致的論點)

【評論主題】4. If you want to_______the possibility of a cockroach infestation, clean yourkitchen regularly.(A)

【評論內容】4. If you want to_______the possibility of a cockroach infestation (滋擾), clean your kitchen regularly.

【評論主題】6. A continuation of chronic lateness may lead us to_______your employment.(A)tantalize (B) terminat

【評論內容】6. A continuation of chronic lateness (習慣性遲到) may lead us to_______your employment.

【評論主題】5. Johnny cursed and_______against the injustices of the system.(A)railed (B)ratified (C) rated (D)r

【評論內容】5. Johnny cursed and_______against the injustices of the system.

【評論主題】3. However, there is a sense that these changes will last. This_______is drawn from thebelief that P

【評論內容】3. However, there is a sense that these changes will last. This_______is drawn from the belief that President Samia has now fully consolidated (加強，鞏固的) her grip on the ruling party.

【評論主題】2. Violins, cameras, school desks； computer mouses, can openers -- these are just afew items that de

【評論內容】2. Violins, cameras, school desks； computer mouses, can openers -- these are just a few items that demonstrate how routinely _______ left-handers are in this world.

【評論主題】75. Which of the following is with the same binding site as O2 in hemoglobin?(A)CO(B)CO2(C) NO2(D) 2

【評論內容】75. Which of the following is with the same binding site as O2 in hemoglobin?

【評論主題】53. Which of the following vitamins is correctly associated with its use?(A) Vitamin C - curing rick

【評論內容】53. Which of the following vitamins is correctly associated with its use?

【評論主題】1. Addressing the needs of health-care workers in the forefront of COVID-management is a high_______

【評論內容】1. Addressing the needs of health-care workers in the forefront (前沿,前線) of COVID-management is a high_______.

【評論主題】28.ST-segment elevation myocardial infarction（STEMI）發作，且無法於120分鐘內進行PCI時，最適合採用下列何者治療？ (A)alteplase (B

【評論內容】28.ST-segment elevation myocardial infarction（STEMI）發作，且無法於120分鐘內進行PCI時，最適合採用下列何者治療？

【評論內容】29.70歲男性，因高血壓、心衰竭，長期服用下列藥品，入院時心電圖顯示為first-degree AV block，最可能與其所服用的那些藥品有關？①amlodipine 5 mg QD ②digoxin 125 μg QD ③furosemide 40 mg QD ④metoprolol 25 mg QD

【評論主題】22 下列 HMG-CoA inhibitors 藥品中，那一個在人體內的血漿中半衰期 (plasma half-life) 最長？(A)Lovastatin(B)Simvastatin(C)Fluv

【評論內容】根據課本描述 Basic & C☆☆☆☆☆☆☆...

【評論主題】1. The presidential candidate involved in the corruption scandal is struggling to salvage hisreputat

【評論內容】1. The presidential candidate involved in the corruption scandal is struggling to salvage his reputation.

【評論主題】4.Which of the following amino acid substitutions would be least likely to have a detrimental effect

【評論內容】4.Which of the following amino acid substitutions would be least likely to have a detrimental effect on protein folding and function?

【評論主題】7.His_______for detail leads him to examine the report multiple times for possibleinconsistencies.(A

【評論內容】7.His_______for detail leads him to examine the report multiple times for possible inconsistencies. (不一致的論點)

【評論主題】6. A continuation of chronic lateness may lead us to_______your employment.(A)tantalize (B) terminat

【評論內容】6. A continuation of chronic lateness (習慣性遲到) may lead us to_______your employment.

【評論主題】5. Johnny cursed and_______against the injustices of the system.(A)railed (B)ratified (C) rated (D)r

【評論內容】5. Johnny cursed and_______against the injustices of the system.

【評論主題】4. If you want to_______the possibility of a cockroach infestation, clean yourkitchen regularly.(A)

【評論內容】4. If you want to_______the possibility of a cockroach infestation (滋擾), clean your kitchen regularly.

【評論主題】3. However, there is a sense that these changes will last. This_______is drawn from thebelief that P

【評論主題】2. Violins, cameras, school desks； computer mouses, can openers -- these are just afew items that de

【評論內容】2. Violins, cameras, school desks； computer mouses, can openers -- these are just a few items that demonstrate how routinely _______ left-handers are in this world.

【評論主題】53. Which of the following vitamins is correctly associated with its use?(A) Vitamin C - curing rick

【評論內容】53. Which of the following vitamins is correctly associated with its use?

【評論主題】3.______connect the intermediate filament system of two adjacent epithelial cells.(A) Adherent junct

【評論內容】3.______connect the intermediate filament system of two adjacent epithelial cells.

【評論主題】1. Addressing the needs of health-care workers in the forefront of COVID-management is a high_______

【評論內容】1. Addressing the needs of health-care workers in the forefront (前沿,前線) of COVID-management is a high_______.

【評論主題】41.下列何者可能導致乳酸中毒（lactic acidosis）？①休克 ②癲癇 ③一氧化碳中毒 ④惡性腫瘤(A)僅①③ (B)僅①②④ (C)僅②③④ (D)①②③④

【評論內容】41.下列何者可能導致乳酸中毒（lactic acidosis）？①休克 ②癲癇 ③一氧化碳中毒 ④惡性腫瘤

【評論主題】21.下列何者不適合用於治療結構型心臟病（structural heart disease，如左心室肥大，心肌梗塞或心衰竭）病人的心律不整？ (A)carvedilol (B)digoxin (C)p

【評論內容】21.下列何者不適合用於治療結構型心臟病（structural heart disease，如左心室肥大，心肌梗塞或心衰竭）病人的心律不整？

【評論主題】27.下列何者用於急性心肌梗塞（AMI）病人之心室性心律不整時，不會增加死亡率？(A)amiodarone (B)encainide (C)flecainide (D)moricizine

【評論內容】

當初考試時沒查資料前怎麼解題的：看到心律不整沒有禁忌症的病人選Amiodarone大概8成不會錯高級心臟救命術(ACLS)心搏停止(常常發生在患者心肌梗塞後)用藥三寶：Epinephrine , Amiodarone, Lidocaine詳解摘要：

27.下列何者用於急性心肌梗塞（AMI）病人之心室性心律不整時，不會增加死亡率？

【評論主題】26.根據實證，下列何者在急性冠心症（ACS）的治療上不具有角色？(A)ACE inhibitors (B)aspirin (C)quinidine (D)heparin

【評論內容】26.根據實證，下列何者在急性冠心症（ACS）的治療上不具有角色？

【評論主題】23 將降血脂藥物 lovastatin 的內酯結構開環，所得到優點為：(A)藥物吸收增加(B)副作用降低(C)作用時間增長(D)代謝降低

【評論內容】Lovastatin(Prodrug)P☆☆☆☆☆☆☆☆☆☆...

【評論主題】61.下列併用藥品組合，何者不合理？(A)dobutamine 2 μg/kg/min IV infusion with titration－dopamine 5 μg/kg/min IV infus

【評論內容】(A) dobutamine 2 μg/☆☆/☆☆☆ ☆☆ ...

【評論主題】76.面積小於2%之灼燙傷，下列何者較適合使用非處方藥自我照護？(A)22歲健康男性，熱水燙傷臉部，傷及表皮層 (B)40歲女性，有氣喘病史，熱水燙傷手指，傷及真皮層 (C)50歲女性，有糖尿病，熱水

【評論內容】看來當(救護)義消還會對藥師國考有幫助 ...

【評論主題】43.Isoniazid引發之肝傷害具下列何種特性？(A)膽汁鬱積性（cholestatic） (B)特異體質性（idiosyncratic） (C)生物轉化性（bioactivation） (D)破

【評論內容】

*跟解題無關只是提問*

有點不太確定是不是可以理解成 Isoniazid同時為Idiosyncratic跟Bioactivation所致的肝傷害?有些文獻會寫他是Idiosyncratic DILI(Drug Induced Liver Injury)不太確定兩者定義上有沒有相斥E.g. 2019年NEJM的DILI文獻提及Common causes of drug-induced idiosyncratic acute hepatocellular injury are isoniazid, nitrofurantoin, and diclofenac.不過後來查到一篇2016年的文獻現在貌似有發現有其他的假說Previous mechanistic hypotheses have classified this type of drug‐induced liver injury (DILI) as ‘metabolic idiosyncrasy’ which was thought not to involve an immune response and was mainly due to th...

【評論主題】31.有關fibrinolytics治療之敘述，下列何者正確？(A)NSTE-ACS的病人在症狀發生的12小時內給與，才能達到臨床效益 (B)為達到最好的臨床效益，到達醫院後30分鐘內應確立STEMI

【評論內容】居然被高級心臟救命術(ACLS)題目銃康 ★★...

【評論主題】6.腹瀉病人有輕微或中度脫水者，應如何進行體液補充（rehydration）最適當？(A)因症狀較輕微，不需要特別補充 (B)儘量多喝市售運動飲料，避免脫水 (C)使用點滴注射，因效果遠優於口服補充液

【評論內容】

關於口服體液補充（rehydration）可以看仁醫第三集來加強印象喔（喂

#看劇救國考補個國考點(hypovolemia)輕微低血容積 (3 ~ 5% 體液流失)患者會有比較少的尿液量(Urine output)中度低血容積 (6 ~ 9% 體液流失) 症狀會變明顯，開始有前期休克的徵象如心搏過速，姿勢型血壓下降，皮膚張力(turgor)下降，黏膜乾乾的(dry mucous membranes)，周邊血管灌流狀況變差 (壓指甲床的時候，把指甲床壓白，然後指甲床從白色變回紅色的時間>2秒或3秒)，或是呼吸變深(變快或不變都有可能)嚴重低血容積 (≥10% 體液流失) 會有很像休克的徵象低血壓, 周邊血管灌流狀況變差(壓指甲床>3秒), 冷且斑駁的四肢, 嗜睡, 深呼吸且呼吸變快. 這個階段就需要很激進的(Aggressive)補充體液來防止組織灌流不足而受傷。參考資料：Adapted from UpToDate

【評論主題】27.依西藥藥品優良製造規範有關運送之規定，所稱「環境溫度」，意指：(A)非冷藏藥品所需的儲存溫度 (B)在我國，與「室溫」同義，可互換使用 (C)係用於藥品冷鏈運送之風險管理專業術語 (D)此溫度的

【評論內容】

環境溫度：非冷藏藥品所需的儲存溫度；通常於產品上標示為儲存於25度以下或儲存於30度以下參考資料：西藥藥品優良製造規範（第三部運銷）

【評論主題】34.下列有關第一等級醫療器材之敘述，何者正確？(A)因第一等級醫療器材之風險較低（如紗布，OK繃等），輸入、製造時，無須向衛生福利部申請查驗登記，惟標示仍需符合醫療器材管理法第33條規定 (B)未

【評論內容】藥物優良製造準則第62條第二等級、第三等級及第一等級"非"屬醫療器材管理辦法附件二所列未滅菌或不具量測功能品項之醫療器材，其製造業者，應符合本編第二章之規定。(aka標準模式)第一等級列屬醫療器材管理辦法附件二未滅菌或不具量測功能品項之醫療器材，其製造業者，應符合本編第三章之規定。(aka精要模式)本編第三章規定自發布日起一年後施行。根據醫療器材管理法第18條中央主管機關應視醫療器材使用風險，公告特定醫療器材之種類、品項，限制其販售或供應型態。衛生福利部食品藥物管理署 通訊交易通路販售醫療器材之品項及應遵行事項 提及：於通訊交易通路販售醫療器材者，應符合下列資格之一：　　(一) 依本法第十三條規定核准登記之醫療器材商。　　(二) 依藥事法第三十四條規定核准登記之藥局。於前點通路販售之醫療器材，以第一等級及附件所列之第二等級醫療器材品項為限。醫療器材管理法第25條製造、輸入醫療器材，應向中央主管機關申請查驗登記，經核准發給醫療器材許可證後，始得為之。但經中央主管機關公告之品項，其製造、輸入應以登錄方式為之。醫療器材管理法第35條有下列情形之一者，中央主管機關得專案核准特定醫療器材之製造或輸入，不受第二十五條第一項規定之限制：一、為預防、診治危及生命或嚴重失能之疾病，國內尚無合適替代療法。二、因應緊急公共衛生情事之需要。三、試驗用醫療器材。四、專供樣品或贈品之用，或個人自用。五、輸入專供維修，且修復後非於國內流通販賣。六、依前條第四項公告為必要醫療器材之許可證產品，有無法繼續製造、輸入或不足供應之情形。前項專案核准之申請條件、審查程序、核准基準、供售限制、退運及其他應遵行事項之辦法，由中央主管機關定之。

【評論主題】30.依西藥藥品優良製造規範之規定，下列何者為藥品製造之關鍵人員？(A)營運主管 (B)廠長 (C)生產主管及品質主管 (D)工廠裡每一個員工

【評論內容】

高層管理者應任命關鍵管理人員，包括生產主管，品質管制主管，以及如果這兩個人中至少有一位不負責產品之放行時，為放行之目的所指定的被授權人參考資料：西藥藥品優良製造規範（第一部）

【評論主題】26.下列有關醫師調劑之規定，何者正確？(A)所聘藥師離開調劑處所時，醫師得親自調劑 (B)醫師於調劑後，須在病歷上簽名，並加註日期 (C)限調劑自開含麻醉藥或毒劇藥之處方 (D)曾犯毒品危害防制條例

【評論內容】藥事法第102條

【評論主題】15.藥師法對於醫療機構聘藥師提供藥品調劑服務之規定，下列敘述何者正確？(A)醫療機構所聘藥師，至少二人應具備二年以上實際調劑執業經驗，始得提供藥品調劑服務 (B)醫療機構所聘藥師，均需具備一年以上實

【評論內容】藥師法第20-1條

【評論主題】48.下列藥品與可能造成畸胎類型的配對，何者錯誤？(A)lamotrigine－唇顎裂(B)methotrexate－中樞神經和四肢畸形(C)streptomycin－第八對腦神經受損(D)vitam

【評論內容】

孕婦服用高劑量的Vitamin A本身也有致畸胎性就是了只是多數主要是發生"神經塉缺陷(cranial neural crest)"

參考資料：

ROTHMAN, Kenneth J., et al. Teratogenicity of high vitamin A intake. New England Journal of Medicine, 1995, 333.21: 1369-1373.

【評論主題】57.下列處方何者錯誤？(A)enalapril 20 mg TID PO (B)losartan 50 mg BID PO (C)amlodipine 10 mg QD PO (D)bisoprol

【評論內容】

分享一下AHA 2017年高血壓指引的常用口服高血壓藥物表格Captopril是唯一可以三天一次的(TID) 最少要BID其他可以BID的ACEI/ARB(都可以QD服用)包含BenazeprilEnalaprilMoexiprilQuinaprilRamiprilEprosartanLosartan其他不是QD的首選高血壓藥還有：Isardipine (BID)Nicardipine (BID)Verapamil IR (TID)Verapamil SR (BID/QD)其他首選的降血壓藥(Thiazide, ACEI, ARB, CCB)全部都是QD服...

【評論主題】14.下列何者為急性細菌性咽喉炎（pharyngitis）之首選藥品？(A)amoxicillin(B)clarithromycin(C)levofloxacin(D)tetracycline

【評論內容】

小弟在醫院實習期間剛好有大概摸過這個主題，分享一下筆記大多咽喉炎是病毒感染（但是多為自限性）細菌性咽喉炎，多為Group A Streptococcus(GAS)感染，佔15~30%小朋友咽喉炎GAS感染咽喉炎和感冒很像，且需要抗生素及時介入，不然有可能會進展成急性風濕熱（有致死風險）所以可以用Modified Centor criteria (McIssac)大致針對症狀去推測感染GAS風險後，再去做抗原測試

Modified Centor criteria

沒有咳嗽症狀+1前頸淋巴結腫大+1發燒(>38度以上)+1扁桃腺分泌物或腫大+13~14歲+115~44歲045歲以上-1

抗生素首選藥原本應為Penicillin V，但是臺灣貌似沒有這個藥所以首選變成了Amoxicillin 50 mg/kg (1000 mg) QD或 25 mg/kg (500 mg...

【評論主題】209.人體的頸椎中共有幾節?(A)5 (B)6(C)7 (D)8

【評論內容】人類脊椎共有24塊頸椎C-Spine 7★★★☆-...

【評論主題】186.手臂是由那二根骨組成：(A) 尺骨和橈骨 (B) 橈骨和腕骨 (C) 腕骨和掌骨 (D) 尺骨和腕骨

【評論內容】尺骨和橈骨橈骨是當你將手向上翻的時候在...

【評論主題】166.下列那一個不是軸心骨(A)頸(B)下肢 (C)軀幹 (D)頭

【評論內容】根據消防署中級救護手冊人體骨骼可分為軸心...

【評論主題】146. 下列何者排列順序為空氣進入胸腔的正確途徑a. 肺泡 b.氣管 c.鼻腔 d. 喉頭 e. 小支氣管 ?(A)deabfcg (B)cdeba (C)cdbea(D)cdebc

【評論內容】呼吸道路徑原則上鼻腔->鼻咽-&g☆;★★-...

【評論主題】293. 於無意識的病人EMT 常檢查那一條動脈：(A) 頭動脈 (B) 橈動脈 (C) 臂動脈 (D) 頸動脈。