【justin1999031】點評問題和點評內容

【評論主題】1.19歲女性病患，自述過去身體健康，並無酗酒或病毒性肝炎病史。因為近一個月來下肢浮腫和血液檢查發現肝功能異常就醫。在外院腹部超音波顯示肝硬化。血液檢查發現albumin：3.2 g/dL；AST（G

【評論內容】Both functions of ATP7B are dysfunctional in Wilson disease. Copper accumulates in the liver, and ceruloplasmin is secreted in a form that lacks copper and is rapidly degraded in the bloodstream.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】1.19歲女性病患，自述過去身體健康，並無酗酒或病毒性肝炎病史。因為近一個月來下肢浮腫和血液檢查發現肝功能異常就醫。在外院腹部超音波顯示肝硬化。血液檢查發現albumin：3.2 g/dL；AST（G

【評論內容】Both functions of ATP7B are dysfunctional in Wilson disease. Copper accumulates in the liver, and ceruloplasmin is secreted in a form that lacks copper and is rapidly degraded in the bloodstream.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】29.在懷孕全程，母親血液中的下列何種荷爾蒙濃度並不會隨著妊娠週數增加而持續增加？(A)雌二醇（estradiol） (B)雌三醇（estriol） (C)人類絨毛膜刺激激素（human chorio

【評論內容】HCG is found in your urine or blood around 10 to 11 days after conception (when a sperm fertilizes an egg). Your hCG levels are the highest towards the end of the first trimester (10 weeks of pregnancy), then decline for the rest of your pregnancy. Human chorionic gonadotropin is a hormone produced primarily by syncytiotrophoblastic cells of the placenta during pregnancy. The hormone stimulates the corpus luteum to produce progesterone to maintain the pregnancy. Smaller amounts of hCG are also produced in the pituitary gland, the liver, and the colon. Most experts theorize that the reason for changes in hCG levels is that, at a certain point in the pregnancy, the placenta takes over making the hormones estrogen and progesterone. This means hCG is no longer needed to stimulate the ovary to make hormones, says Dr. Ross. During pregnancy, you make high levels of estriol, a type of estrogen hormone. This hormone keeps you uterus healthy and helps it grow along with the developing baby. Estriol levels peak toward the end of pregnancy to get your body ready for childbirth and breastfeeding. Estriol is produced by the placenta by the conversion of 16-hydroxy-dehydroepiandrosterone sulfate to androgens, which are subsequently aromatized to estriol.

【評論主題】24.下列何種免疫抑制劑作用於 T 淋巴球活化過程中的 costimulatory pathway？(A)tacrolimus (B)mycophenolate mofetil (C)sirolimu

【評論內容】https://app.yamol.tw/item/2403396

【評論主題】8.有關懷孕週數 40 週新生兒的身體診察，下列何者最為異常？(A)體重 3.3 公斤 (B)身長 50 公分 (C)頭圍 38 公分 (D)體溫 36.8℃

【評論內容】HC=BL/2 +10

【評論主題】8.下列何項關於人體器官移植的陳述是錯誤的?(A)器官移植術後的排斥主要是跟人類白血球抗原(human leukocyte antgen有關·此抗原基因在第六對染色體上(B)器官移植術後的超急性排斥(

【評論內容】Hyperacute rejection is usually caused by specific antibodies against the graft and occurs within minutes or hours after grafting. Acute rejection occurs days or weeks after transplantation and can be caused by specific lymphocytes in the recipient that recognize HLA antigens in the tissue or organ grafted...

【評論主題】3.有關自體免疫疾病在男性與女性之間,其發生率(incidence與特色得敘述，下列何者最不適當?(A)自體免疫甲狀腺疾病(autoimmunethyroiddiseases)、硬皮症(sclerod

【評論內容】

A study in Sweden spanning from 1983 to 2002 found an annual incidence rate of 16.4/100,000 for males and 8.9/100,000 for females [1]. The differences decreased slowly with age, but the prevalence remained higher in men with an overall male/female ratio of 1.8. When compared to men with type 1 diabetes, women with type 1 diabetes had two times the risk of fatal and nonfatal cardiovascular events, as well as 40% greater excess risk for all-cause mortality.

【評論主題】54.糖皮素（glucocorticoids）最不可能出現下列何種副作用？(A)抑制生長 (B)抑制腎上腺 (C)高血鈣 (D)胰島素抗性

【評論內容】Steroids cause bone loss by a variety of mechanisms. They act to decrease absorption of calcium from the intestine, and increase urinary calcium loss. This leads to the development of secondary hyperparathyroidism, which results in bone resorption.

【評論主題】51.下列何者不是子宮頸陰道鏡檢查下侵犯性病灶的特徵？(A)異常網狀血管 (B)不規則表面合併上皮潰爛 (C)醋酸塗抹後上皮白化 (D)因血管增生或表皮壞死造成的顏色改變

【評論內容】檢查過程中會使用棉棒將子宮頸黏液或過量的分泌物除去。為了使不正常的細胞容易顯現，有時醫師會在子宮頸塗抹冰醋酸（acetic acid），受檢查者會有些許冰冷和刺痛的感覺；冰醋酸可以溶解子宮頸黏液，並且讓細胞脫水以及細胞內的蛋白質凝集，使得出現病變的區域更容易被觀察，例如：白色上皮（white epithelium）、出現小點的區域（punctation）、鑲嵌的區域（mosaic）以及異常的血管（atypical vessels）。塗抹冰醋酸的效果在兩分鐘左右最佳，五分鐘之後就漸漸消退，因此檢查醫師可能為了讓檢查更確實，而有需要重覆塗抹冰醋酸數次，塗過冰醋酸之後的子宮頸可能會變白，變白的區域稱為白色上皮（white epithelium），白色上皮區通常會伴隨著子宮頸細胞異生（dysplasia），醫師會在此區域做切片檢查，讓病灶定位更加精確。

【評論主題】21.有關巴特氏額頭膨腫（Pott puffy tumor），下列敘述何者正確？(A)病因是篩骨（ethmoid bone）的骨膜下膿瘍（subperiosteal abscess）及骨髓炎（oste

【評論內容】Pott puffy tumor is a forehead swelling due to frontal bone osteomyelitis with associated subperiosteal abscess. PPT is a rare complication of sinusitis, but can also occur due to trauma. PPT is most commonly seen in the pediatric and young adolescent populations due to the pneumatization process and venous drainage.

【評論主題】62.針對細菌性腦膜炎病人的診斷，下列有關腦脊髓液（CSF）檢查之敘述何者錯誤？(A)超過一半病人的 CSF 會有 polymorphonuclear（PMN）白血球增加至＞100 cells/μL

【評論內容】The sensitivity of the Gram stain in community-acquired bacterial meningitis ranges between 60% and 90% and varies by the concentration of the bacteria in the CSF, by the type of meningeal pathogen, and by the receipt of previous antibiotic therapy.

【評論主題】54.下列有關糖尿病與心臟血管疾病的敘述，何者最不恰當？(A)糖尿病會增加心肌梗塞及心臟衰竭的發生率 (B)有心肌梗塞或心臟衰竭的病人都不可以使用 metformin (C)aspirin 及 sta

【評論內容】The use of metformin after acute myocardial infarction (AMI) has been associated with reduced mortality in people with type 2 diabetes mellitus (T2DM). However, it is not known if it is acutely cardioprotective in patients taking metformin at the time of AMI.

【評論主題】32.一位 72 歲男性病人手部有 clubbing of fingers 的症狀，手部 X 光檢查發現有 hypertrophic osteoarthropathy，此病人的這些臨床特徵與下列何種疾

【評論內容】Hypertrophic pulmonary osteoarthropathy is a condition that affects some people with lung cancer. It most often causes inflammation of bones and joints in the wrists and ankles. Another common symptom is clubbing of the fingers.

【評論主題】31.關於 sarcoidosis 疾病的描述，下列何者最適當？(A)主要致病機轉為 B 細胞的活化和自體免疫抗體的產生，再經 antibody-dependent cell-mediated cyt

【評論內容】

類肉瘤病(Sarcoidosis)的病理特徵為非乾酪性的肉芽腫(noncaseating granulomas)，可發生於許多組織及器官。最常見的表現為胸部X光或電腦斷層看到有雙側肺門部的淋巴腺腫。

類肉瘤病較常發生於女性病因不明。幾乎所有病患都有淋巴結侵犯，肺臟為常被侵犯的器官。另外四分之三的病人會有脾臟的侵犯。肝臟的侵犯比脾臟略少，三分之一至二分之一的病人會有皮膚的侵犯、另外還可以侵犯至骨髓、眼睛、唾腺。

症狀

輕微時可以沒有症狀，偶然在X光檢查中發現。或是一些呼吸道的症狀包括喘、咳、胸痛及咳血。及發燒、疲勞、體重減輕、盜汗等。

治療類固醇(glucocorticoids)

【評論主題】22.下列何種情況不是肝細胞癌（hepatocellular carcinoma）的高危險群？(A)B 型肝炎帶原者 (B)慢性 C 型肝炎 (C)肝鈣化點（calcified spot of liv

【評論內容】

肝臟為何出現鈣化點，一般推測，可能和過去身體受到感染，產生發炎後的癒合有關，例如曾感染肺結核、寄生蟲等；另外，肝臟發育不良、肝內膽管結石，都可能在肝臟內部形成鈣化點，只是肝內膽管結石在超音波下呈線狀排列。

理論上，單純的鈣化點不會變大，也不會有症狀，對肝臟健康沒有影響，唯一要注意的是，有些腫瘤，如大腸癌轉移至肝臟時，腫瘤內部會有鈣化點，此屬異常情況，有經驗的專科醫師不難判讀。

鈣化點是否會變成肝硬化？一般而言，肝的鈣化點單獨存在，與肝硬化沒有關聯，有鈣化點出現，不表示肝硬化有惡化的徵兆，一旦肝纖維化，不會只有一、兩個鈣化點，肝臟將呈現整片結痂或纖維化。

【評論主題】21.下列何者不是胰腺癌（pancreatic adenocarcinoma）的常見症狀？(A)體重減輕 (B)黃疸（jaundice） (C)背痛 (D)低血糖

【評論內容】The pancreas normally produces two hormones called insulin and glucagon which keep the amount of glucose in your blood at the right level. If you have pancreatic cancer, you may not produce enough of these hormones. This means that your blood sugar level may become too high – this is diabetes.

【評論主題】18.關於大腸直腸癌的敘述何者正確？(A)起源於右側結腸的腫瘤預後比左側結腸的好 (B)肺部是大腸癌最容易轉移的內臟器官 (C)血清 carcinoembryonic antigen（CEA）是用來篩

【評論內容】有些民眾會選擇去做抽血驗CEA（Carcinoembryonic antigen，癌胚抗原又稱腫瘤標記），來診斷是否有大腸癌。事實上CEA並不是用來「早期診斷」癌症的工具，而是做為追蹤癌症治療效果的參考指標，指數正常不代表沒事，不正常也不一定就是有癌症。由於許多良性及惡性病因都有可能使CEA升高，且正常的CEA值也不代表體內無相關癌病，有近半數的相關癌症病人，其CEA值仍可能在正常，因此 CEA的敏感性及特異常不佳，並不適合做為篩檢早期癌之用。

【評論主題】15.68 歲李女士，30 年前因輸血感染 C 型肝炎，目前 AST：100 U/L，ALT：126 U/L，HCV genotype 1，腹部超音波下無肝硬化，下列敘述何者錯誤？ (A)李女士應定期

【評論內容】DAA (direct acting anti viral agent) 已成為第一線用藥(傳統的副作用多)

【評論主題】11.一位 65 歲女性因胸悶至門診，十二導程心電圖發現有心房顫動。為了評估之後缺血性中風風險，可以使用CHA2DS2-VASc score。下列何者不是CHA2DS2-VASc score 之計分

【評論內容】stroke那欄專指體動脈栓塞，不包含PE, DVT。The confusion within this component of the CHA2DS2-VASc score comes from the inclusion of TE. There are several areas within the original validation trial that would infer thatdeep vein thrombosis (DVT) or pulmonary embolism (PE) would be included within the score1. A key point in clarifying this component is to define “systemic embolism”. The term“systemic” implies that the clot develops in the left-side of the heart and the embolism will be pushed “systemically” or via the arteries. Specifically, the ARISTOTLE trial defined systemic embolism as requiring “a clinical history consistent with an acute loss of blood flow to a peripheral artery (or arteries) supported by the evidence of embolism from surgicalspecimens, autopsy, angiography, vascular imaging, or other objective testing.”4 By these definitions, DVT and PE would not be included within the CHA2DS2-VASc score; however,a DVT and/or PE identifies a high-risk population for recurrent embolisms and might need to be evaluated independently in clinical decisions within anticoagulation therapy8https://meddataspeaks.wordpress.com/2014/09/04/%E8%87%A8%E5%BA%8A%E8%97%A5%E5%AD%B8-cha2ds2-vasc-score%E5%92%8C-has-bled-score/.

【評論主題】35.有關小腸腫瘤，下列敘述何者最恰當？(A)良性腫瘤最常見為脂肪瘤，通常無症狀 (B)最常見的惡性腫瘤為腺癌，好發於迴腸 (C)類癌（carcinoid）易合併類癌症後群（carcinoid syn

【評論內容】小腸最常見良性: liomyoma最常見惡性: adenocarcinoma(40%)，carcinoid(25%)adenocarcinoma 50% 好發12指腸lymphoma多見於迴腸

【評論主題】32.短腸症（short bowel syndrome）為大量切除小腸之後的長期併發症。下列何者不是短腸症發生的危險因子（riskfactors）？ (A)空腸切除（jejunal resection

【評論內容】Short bowel syndrome (SBS) in adults is defined as less than 180 to 200 centimeters of remaining small bowel (normal length 275 to 850 cm) leading to the need for nutritional and fluid supplements.

【評論主題】31.脾臟（spleen）可視為人類最大的淋巴器官，具有調節免疫系統的功能，下列對於脾臟切除（splenectomy）的敘述何者錯誤？ (A)嚴重肝硬化的病患經常合併血小板減少（thrombocyto

【評論內容】Since the spleen is the largest lymphoid organs with large amount of T and B cells, macrophages, and dendritic cells, splenectomy in cirrhotic patients has produced concern over decrease immunity and elevated risk of infection, namely overwhelming post splenectomy pneumococcal sepsis.

【評論主題】22.有關深層靜脈栓塞（deep vein thrombosis），下列敘述何者錯誤？(A)危險因子包括年齡、惡性腫瘤、先前手術及靜脈栓塞病史 (B)Virchow's triad 可解釋靜

【評論內容】May-Thurner syndrome occurs when your right iliac artery compresses your left iliac vein. This compression disrupts blood flow and may lead to DVT.

【評論主題】12.關於 Chiari I herniation 的敘述，下列何者錯誤下列何者錯誤？ (A)延髓（medulla）向下疝出，超出 foramen magnum 位置 (B)可能產生四肢麻木、無力情形

【評論內容】

Chiari malformations, types I-IV, refer to a spectrum of congenital hindbrain abnormalities affecting the structural relationships between the cerebellum, brainstem, the upper cervical cord, and the bony cranial base.Classification is based on the morphology of the malformations [4] :

Chiari I: >5mm descent of the caudal tip of cerebellar tonsils past the foramen magnum.

【評論主題】8.有關生殖細胞瘤（germinoma）之敘述之敘述，下列何者錯誤？ (A)占 primary CNS tumor 約 1～2 % (B)90%以上發生於 20 歲前(C)50%長在 pineal r

【評論內容】Although rare, pure pineal germinoma can be found in female subjects. On the basis of the literature review, the male/female ratio in cases of pure pineal germinoma is between 5:1 and 22:1 (mean 14:1).

【評論主題】5.高壓氧（hyperbaric oxygen therapy）為一有效改善組織缺氧之療法，應用於傷口組織缺氧治療最主要之先決條件為何？ (A)病人本身多重合併症需獲得良好控制 (B)確認傷口標的物本

【評論內容】一、何謂高壓氧治療?是一種間斷性、高濃度而短時間的氧氣呼吸治療法。高壓氧治療為將病人置於一個完全密閉的壓力艙內，治療時會將艙內壓力加壓及使病患呼吸100%的純氧，一方面以高濃度氧氣置換出體內有毒氣體 (如一氧化碳)以治療氣體中毒；另一方面藉由大幅增加身體組織微循環氧分壓，改善身體組織缺氧及增加細胞存活，如此治療方式稱為高壓氧氣治療。

【評論主題】1.病人主訴頻尿，每次尿量都很多，並未使用利尿劑。收集 24 小時尿液檢查結果：總尿量 3500 mL/day，urineosmolality 450 mosmol/L。病人的檢查數值，最符合下列那一

【評論內容】serum osm range: 275~295其他資源https://thetinynotes.com/topic/1175/%E5%A4%9A%E5%B0%BFpolyuriafc腎臟高血鈉

【評論主題】77.有關孕婦急救，下列敘述何者錯誤？(A)懷孕婦女造成心臟停止（cardiac arrest）的原因，主要是跟懷孕相關的併發症最有關係 (B)嚴重外傷的孕婦，昏迷不醒需要心肺復甦術（cardiopu

【評論內容】Modifications to Standard ACLS Protocol Necessary in Pregnant Patients.左側躺、標準ACLS與劑量、4分鐘若失敗臨死前接生

【評論主題】73.一位65歲男性被診斷為肺癌第四期，預期生命不超過3個月的末期病人，他自述有呼吸困難（dyspnea）的症狀，胸部X光顯示腫瘤有逐漸增大現象，其氧氣飽和度（oxygen saturation）在不

【評論內容】Tramadol等鴉片類藥物可減緩呼吸速率、減少呼吸中樞對低血氧及高二氧化碳感受性，舒緩呼吸困難導致的窒息感。

【評論主題】30.32歲女性，G4P0，因少量陰道出血、左下腹微痛、自行驗孕呈陽性反應而來門診就醫，最後一次月經開始日為5週前，這位女性在本次懷孕之前已有兩次早期懷孕合併流產病史、最近的一次懷孕為子宮外孕並接受藥

【評論內容】b-HCG照理懷孕四到六周之前(2000以下時)，每兩天翻倍(接下來每四天翻倍)，依照醫師指示兩天後持續抽血追蹤，若沒有翻倍則可能為子宮外孕或生化流產*。

【評論主題】29.下列何者不是子宮外孕使用methotrexate治療的禁忌症（contraindications）？(A)糖尿病（diabetes） (B)哺乳（breastfeeding） (C)血小板低下症

【評論內容】為啥大家都會寫?!ep, ectopic pregnancy

【評論主題】61.關於初次發生、未曾使用過抗生素預防或治療的腹膜炎，其致病原與抗生素治療，下列敘述何者錯誤？(A)肝硬化病人發生原發性細菌性腹膜炎（primary bacterial peritonitis）的經

【評論內容】The most common bacteria causing SBP are gram-negative Escherichia coli and Klebsiella pneumoniae and gram-positive Streptococcus pneumoniae; usually only a single organism is involved.Historically, gram-negative bacteria were the main causative agents of spontaneous bacterial peritonitis, with Escherichia coli and Klebsiella spp. being the most frequently isolated organisms.22–25 However, major changes in the bacteriology of infections in patients with cirrhosis occurred over the last few decades with an increasing prevalence of gram-positive, quinolone-resistant, and multidrug-resistant bacteria.1,22,26 A rising prevalence of gram-positive bacteria was reported over the past years in North America, South America, and Europe representing at present 48%–62% of the isolated organisms.4,27,28,54 The most frequent gram-positive isolates are Streptococcus spp., Enterococcus spp., and Staphylococcus spp.4,27 The main isolated microorganisms in patients with spontaneous bacterial peritonitis are shown in Table 2(如下).The crux of this algorithm is Runyon's Criteria for secondary bacterial peritonitis, which requires two of these three features: total protein >1 g/dL, glucose <50 mg/dL (2.8 mM), and lactate dehydrodgenase above the upper limit of normal for serum.

【評論主題】8.下列狀況何者不是壓力催迫性檢查（stress test）的絕對禁忌症？(A)不穩定心絞痛 (B)嚴重心內膜炎 (C)無症狀之主動脈狹窄 (D)嚴重心律不整，且曾併發血行動力學不穩定

【評論內容】目的1.早期偵測或評估冠狀動脈疾病：有心臟病家族史、糖尿病、高血壓及高血脂症患者於健檢時做運動心電圖檢查，約可找出七成無症狀的冠狀動脈性疾病。2.評估心肺功能：現代人大部分工作忙碌且缺乏運動，我們可藉此檢查來評估心肺功能，以瞭解體能及耐力，繼而調整自己日常生活運動量，降低發病的風險。3.日常生活中常感到心悸、胸悶、呼吸困難…等不適的人，可以藉由此項檢查確認有無心臟疾患。4.建議男性40歲、女性50歲以上的人作健康檢查時，可選擇做運動心電圖，而在日常生活中常發生心悸、胸悶、呼吸困難等症狀的人，更要選擇此項檢查；此外，心血管疾病高危險群，如高血壓、高血脂症及心臟病家族史的人也希望能定時做運動心電圖檢查，以達到早期偵測、早期治療目的。 Exercise stress testing is commonly used for the detection of CAD in patients with chest pain or dyspnea on exertion who are at intermediate risk of acute coronary syndrome. Exercise stress testing reduces costs of hospitalization without worsening outcomes in patients presenting to the emergency department with chest pain and negative cardiac enzymes. Exercise stress testing is used to detect inducible cardiac ischemia in symptomatic intermediate-risk patients who can exercise and who have interpretable electrocardiography results.1 Risk is determined by American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines for stable ischemic heart disease or the Diamond and Forrester score to assess pretest probability of coronary artery disease (CAD; Table 1).

【評論主題】59.有關思覺失調症之敘述，下列何者正確？(A)幻覺妄想為思覺失調症最主要之長期核心症狀 (B)haloperidol屬於第二代抗精神病藥物 (C)Eugene Bleuler 的Schizophre

【評論內容】思覺失調症的特徵，根據布洛爾(Bleuler)的長期觀察，認為思覺失調症有四個Ａ的特徵，為其最原始、核心的症狀。這四個Ａ代表四個層面障礙：聯想（association）障礙、自閉（autism）、情感（affect）冷漠及情感矛盾（ambivalence）

【評論主題】45.下列何種磁振造影序列（sequences），對於偵測腦細胞在梗塞數分鐘後所產生細胞毒性水腫（cytotoxicedema）具有最高敏感度？ (A)T1-weighted imaging (B)T

【評論內容】DWI allows the detection of acute ischemic lesions within minutes of the ischemic cerebral event by showing high contrast, and FLAIR provides an advantage over the more conventional T2-weighted imaging for the detection of ischemic lesions, especially for lesions near the cerebral spinal fluid space.

【評論主題】41.下列何種胃部變化與胃癌的癌前變化關聯最大？(A)hyperplastic polyp (B)chronic ulcer (C)atrophic gastritis (D)aberrant pan

【評論內容】In the stomach, chronic atrophic gastritis (CAG) and gastric intestinal metaplasia (GIM) are the two main precursors that precede the development of neoplasia.

【評論主題】26.下列對瓣膜（主動脈瓣或二尖瓣）置換之敘述，何者錯誤？(A)置換機械性瓣膜（mechanical valve）之患者，一般建議需終身使用抗凝血藥物（warfarin） (B)機械性瓣膜（mecha

【評論內容】Immune privilege is a spectrum of evolutionary adaptations that protect vital tissues with limited regenerative capacity from collateral damage by the immune response. There is evidence that heart valves are on the spectrum of immune privileged sites. The mechanism could be related to inhibition of immune cell extravasation in the context of rapid blood flow combined with the vigorous movement of the opening and closing leaflets. This also has important clinical implications for heart valve transplantation.

【評論主題】32.下列有關小腸的敘述,何者錯誤?(A)具有消化、吸收、內分泌的功能,且為體內重要的免疫器官(B)腸道阻塞會因外因性、内因性跟管腔内的病因所造成。最常見的原因是術後沾黏(C)腸胃道基質瘤(gastr

【評論內容】

C.小腸最常見惡性腫瘤為adenocarcinoma，GIST常見於stomach(40-60%), jejunum/ilium(20-35%)D. GIST tumors may spread to the lymph nodes, but this is less common than the liver and peritoneum.

【評論主題】67.15歲女生由媽媽陪同至青少年門診就醫,媽媽詢問施打疫苗的必要性。依據美國預防醫學工作小組(USPreventive Services Task Force)的建議,下列何種疫苗是她目前最不需要接

【評論內容】水痘疫苗 (Varicella)

◎認識疫苗水痘疫苗是一種活性減毒疫苗，可有效避免嚴重之水痘症狀，接種水痘疫苗後若仍感染水痘，其症狀亦較輕微，可能會產生較少的水痘，且較不會發燒，復原較快。◎接種建議

12個月至12歲兒童：出生滿12個月接種第1劑公費疫苗，可於滿4到6歲自費接種第2劑。13歲(含)以上自費接種：未曾接種疫苗且未得過水痘者，應接種兩劑，兩劑間隔四至八週。帶狀疱疹疫苗(Zoster Vaccine)◎認識疫苗帶狀疱疹疫苗是一種活性減毒疫苗，可提高水痘-帶狀疱疹病毒特異性免疫力，預防成人之帶狀疱疹及其併發症。◎自費接種建議50歲(含)以上未曾接種過帶狀疱疹疫苗者，不論之前是否有水痘或帶狀疱疹病史，建議接種1劑活性減毒帶狀疱疹疫苗。

【評論主題】54.受精（fertilization）的過程依序為何？①capacitation ②acrosome reaction ③cortical reaction(A)①②③(B)②①③(C)③①②(D)

【評論內容】capacitation > acrosome > cortical

【評論主題】42.有關子宮肌瘤，下列敘述何者最不適當？(A)多產婦容易長子宮肌瘤(B)吸菸減少了子宮肌瘤的發生率(C)大部分停經後荷爾蒙療法不會刺激肌瘤生長(D)性傳染病不會增加子宮肌瘤發生率

【評論內容】smokingprotective for em cancer, UC, uterine myoma Cigarette smoking is thought to lower endometrial carcinoma risk through one of several anti-estrogenic mechanisms. A sensitivity analysis showed an inverse association between ever smoking and uterine myoma.

【評論主題】26.一位50歲無糖尿病男性,生化檢驗結果呈現血肌酸3.5mg/dL,尿素(40.1mg/d,估算之腎絲球過濾率20mL/min,白蛋白4.0g/dL,血鉀4.1mmol/L,血鈣2.05mmol/L

【評論內容】

26.一位50歲無糖尿病男性，生化檢驗結果呈現血清肌酸酐3.5 mg/dL，尿素氮40.1 mg/dL，估算之腎絲球過濾率20 mL/min，白蛋白4.0 g/dL，血鉀4.1 mmol/L，血鈣2.05 mmol/L，血磷4.5 mg/dL，25(OH) vitamin D 10ng/mL，intact parathyroid hormone 255 pg/mL。下列治療何者最優先？A.cinacalcetB.cholecalciferolC.calcitriolD.ergocalcitriol活性維生素D有一個非常重要的功能是調節血中鈣離子。如果直接吃「活性維生素D」，被吸收後直接進入血液，會很快讓血液中的鈣離子濃度升高，容易產生高血鈣問題，等同中毒。

目前只有洗腎患者(腎臟功能太差)才會建議補充「活性維生素D3」。

一般人建議補充「非活性維生素D3」

【評論主題】24.18歲男性病人,10天前喉痛,當時血液肌酸1.0mgdL·最近4天有高血壓、少尿、水腫、運動性呼吸困難血液肌酸酥1.6mgdL,明顯的補體下降,尿液紅血球25~40/HPF,紅血球圓柱體(RBC

【評論內容】補體下降(low C3)PSGN, MPGN, SLE, Cryoglobulinemia, IE

【評論主題】49.最常發生腦靜脈竇栓塞（cerebral venous sinus thrombosis）的血管為何？(A)上矢狀竇（superior sagittal sinus） (B)下矢狀竇（inferi

【評論內容】The transverse and sigmoid sinuses were thrombosed most often (70% and 53%, respectively).

【評論主題】24.有關食物過敏的敘述，下列何者錯誤？(A)對於雞蛋過敏的小朋友，不可施打 MMR 疫苗（Measles-Mumps-Rubella vaccine） (B)躁動不安、吐奶、腹瀉可能為嬰兒食物過敏之

【評論內容】

近年來，有大量媒體關注MMR 疫苗和自閉症之間的關聯，事實上，已經有許多研究指出這兩者沒有關係。之所以存在著困惑是因為自閉症被診斷出的年齡往往在兒童接種MMR 疫苗左右，因此得出的錯誤結論認為疫苗在某方種導致自閉症。不過，事實上，目前的研究指出，自閉症其實在孩子出生前就有，和疫苗一點都無關。

過去對雞蛋過敏的兒童並不鼓勵接種MMR 疫苗，不過，由於現在MMR 疫苗只含微量的雞蛋蛋白，因此目前政策已經調整，對雞蛋過敏的兒童也可以安全接種MMR 疫苗，無需任何特別的預防措施。此外，如果你的孩子正在服用任何可能會干擾或削弱免疫系統的藥物，這時就不宜接種這個疫苗。

【評論主題】18.5 個月大男嬰，發現肌肉無力來求診，身體診察無肝臟腫大，神經學診察發現面部表情正常，但有四肢低張力及舌頭震顫，最可能為何種疾病？ (A)Spinal muscular atrophy (B)Du

【評論內容】舌頭震顫 >>SMA

【評論主題】16.出生 3 天大之新生兒發生抽搐（Neonatal seizure），下列敘述何者錯誤？(A)較少以 Generalized tonic-clonic seizures 來表現 (B)早產兒容易以

【評論內容】

By far the commonest cause is hypoxic–ischaemic encephalopathy. It may be responsible for 80% of all seizures in the first 2 days of life. Brain damage due to prenatal distress and malformations of cortical development is being increasingly recognised. Seizures in neonates can be difficult to diagnose because they often present with subtle signs and symptoms. 新生兒時期發作臨床表現上與其他時期有相當明顯不同，大部分的發作以局部為主，Subtle seizure(細微發作)為最常發生的類型，而常見於其他時期的全面強直-陣攣發作(Generalized tonic-clonic seizures)幾乎不會在新生兒時期發生。細微發作(Subtle Seizures): 約佔50%，不一定同時發現腦波的不正常放電。常見於足月兒但也可見於早產兒。

眼部動作(Ocular movements)，包含眼球隨意或無意義飄移、雙眼持續性共軛強直的往一邊水平偏移有時可合併眼球抖動(jerking)、不斷眨眼眼瞼顫動、翻白眼、凝視、突然張眼、以及眼球震顫。

【評論主題】50.74歲婦女因下肢無力、容易瘀青、下肢水腫約有3個月而就診。病人有退化性關節炎及骨鬆症，服用alendronate 70 mg/week，calcium citrate及Vit.D，並未服用中藥。

【評論內容】addrenal insufficiency?

【評論主題】72.35歲女性病患，主訴下腹痛，磁振造影檢查發現骨盆腔有囊狀病灶（星號），在T2加權影像（左圖）呈稍低訊號，T1加權影像（右圖）呈高訊號。其診斷為何？ (A)巧克力囊腫（chocolate cys

【評論內容】MRI

Signal characteristics vary according to the age of any complicating hemorrhage 6:

T1

typically, lesions appear hyperintense while acute hemorrhage occasionally appears hypointense

endometriomas with high T1 signal characteristically do not show loss of signal on T1 fat-suppressed sequences, which is important for differentiating it from a mature cystic teratoma of the ovary

T2

typically hypointense owing to the presence of deoxyhemoglobin and methemoglobin (shading sign), which is very suggestive of an endometrioma 3

T2 dark spot sign is specific for chronic hemorrhage and is helpful in diagnosing endometriomas 9

old hemorrhage occasionally appears hyperintense

【評論主題】72.45歲女性病人接受年度健康檢查，發現左腎腫瘤，下圖為注射對比劑之腎臟電腦斷層攝影（computedtomography of kidneys），最可能之診斷為何？ (A)renal cell c

【評論內容】

renal angiomyolipoma> 富含脂肪，超音波白色，ct黑色RCC>arterial phase較腎臟亮，venous phase early washout

【評論主題】3.器官移植病患初期常使用高劑量的類固醇，下列敘述何者錯誤？(A)長期合併類固醇使用仍是移植病患標準的給藥模式 (B)副作用的產生是dose dependent (C)急性排斥往往需要高劑量類固醇注射

【評論內容】類固醇：為最早應用於器官移植的免疫抑制劑，依照目前用藥準則，類固醇可能需服藥一段時間，但為減少其不良反應，建議評估病人病情後逐漸調降劑量，並於適當時機停用。

【評論主題】70.有關酒精戒斷最常見症狀出現的時間先後順序排列，下列何者正確？①幻覺 ②手抖 ③譫妄（delirium）④抽搐（seizure） (A)①②③④ (B)④②①③ (C)②①④③ (D)③②①④

【評論內容】

TPSDtremorpsychotic/ perceptal symptomsseizuredelirium

【評論主題】58.關於治療結核菌腦膜炎的敘述，下列何者錯誤？(A)不可使用類固醇（corticosteroid） (B)如果症狀與腦脊髓液檢查結果皆高度懷疑結核菌腦膜炎，就必須儘早投予抗結核菌藥物 (C)抗結核菌

【評論內容】Adjunctive corticosteroids should be given in patients with TBM, as evidence suggests a mortality benefit. Dexamethasone or prednisolone should be given in a taper during the first 6–8 weeks of treatment.

【評論主題】53.下列有關路易氏體失智症（dementia with Lewy bodies）的敘述，何者錯誤？(A)應儘量使用dopamine agonist以治療病人的parkinsonism的症狀 (B)早

【評論內容】Treatment for DLB involves addressing the symptoms. Medications most often used include Sinemet® and cholinesterase inhibitors, such as galantamine, rivastigmine and donepezil. Other treatments, such as supportive care, physical therapy, and behavioral interventions, may also be used. Acetylcholinesterase (AChE) inhibitors, such as donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl), may help improve hallucinations, confusion and sleepiness in some people. Memantine (glutamate antabonist )is used for moderate or severe dementia with Lewy bodies. It's suitable for those who cannot take AChE inhibitors.

【評論主題】13.有關膽道閉鎖（Biliary atresia）與新生兒肝炎（Neonatal hepatitis）之敘述，下列何者正確？(A)膽道閉鎖的發生率稍高於新生兒肝炎的發生率 (B)肝臟病理切片中，膽道

【評論內容】These include cytomegalovirus, rubella (measles) and hepatitis A, B or C viruses.

【評論主題】9.根據臺灣兒科醫學會指引建議，母親有下列何種狀況仍可以親自哺餵母乳？(A)乳房有活動性單純疱疹（HSV）感染 (B)肺結核菌（Tuberculosis）感染已接受2週適當治療 (C)人類免疫不全病毒

【評論內容】患有水痘的母親有新水泡出現時，肺結核患者在服藥兩週內，都會經由直接接觸嬰兒造成傳染性，所以不宜直接哺乳。但是當水痘患者不再有新皮疹出現，肺結核使用藥物兩週後，就可直接哺乳。患有帶狀泡疹的母親只要乳房沒有病兆，並且能讓嬰兒不接觸到患處時，即可哺乳。下列情況不建議哺餵母乳：(1)愛滋病患者。(2)人類 T 細胞白血病第一型病毒 HTLV-1 感染。(3)使用抗癌症藥物。(4)使用放射性同位素物質--依半衰期而定須暫停哺乳數小時至數天。(5)藥物濫用。下列情況仍可持續哺餵母乳：(1) A 型肝炎、B 型肝炎、C 型肝炎。(2)急性傳染性疾病：呼吸道、腸胃道、泌尿道或生殖系統之感染，常在症狀出現前即傳染給嬰兒，持續哺餵母乳反而可以將母體內抗體傳給嬰兒，減輕其可能之症狀。(3)傳染性結核病：接受抗結核菌藥物治療兩週以上即可哺餵母乳。(4)泡疹病毒：除非乳房上有病兆，否則仍可持續哺餵母乳。(5)水痘：只要母親沒有傳染性(水泡皆結痂)後，即可持續哺餵母乳。(6)乳腺炎，乳房膿瘍。(7)大多數的藥物。(8)抽煙：抽煙可能使奶水分泌減少，對處在二手煙環境下的嬰兒哺餵母乳比喝配方奶的嬰兒不健康。建議母親不要在嬰兒面前及餵奶前抽煙。(9)酒精：美國藥物協會建議母親進食量不要超過每天每公斤 0.5 公克。(10)環境污染及輻射物質：喝配方奶的危險性較喝母乳的大。(11)放射線檢查:X 光、電腦斷層掃描、MRI 核磁共振攝影；即使使用顯影劑亦可以哺餵母乳。(12)施打疫苗:除少數活性病毒疫苗如德國麻疹外。

【評論主題】7.純母乳哺餵之足月新生兒在第5天大時被發現皮膚較黃，檢驗全血清膽紅素值為19 mg/dL，直接型膽紅素值為0.5 mg/dL，下列處置何者最不適合？ (A)可檢驗是否有貧血情形 (B)建議接受膽道胰

【評論內容】

餵食母乳的嬰兒常常會有較久的黃疸，在第四到七天時特別明顯，我們稱作早發型母乳黃疸，膽紅素數值往往比餵食配方奶的嬰兒高。會有這樣的情形主要是因為餵母乳的量、次數及熱量不足，造成膽紅素經腸肝循環的再吸收增加，通常只要增加餵母乳次數和熱量，就可以改善早發型母乳黃疸。

【評論主題】4.關於預防注射的建議，下列何者錯誤？(A)早產兒的預防注射是依出生後年紀施打 (B)早產兒施打五合一疫苗的劑量要減半 (C)施打高劑量免疫球蛋白後11個月內不可施打活性疫苗 (D)B型肝炎疫苗與五合

【評論內容】

A. 經過多個研究之後，目前美國兒科醫學會與疾病管制局對早產兒與低出生體重兒施打疫苗的建議如表一，顯示只要健康狀況良好，並不需要延後施打疫苗。

表一、早產兒與低出生體重兒施打疫苗的建議：

疫苗種類

正常新生兒

早產兒與低出生體重兒

B型肝炎免疫球蛋白

媽媽若為高傳染性B肝帶原者，應於出生12小時內儘快接種，且於嬰兒周歲大時抽血檢驗是否已產生B型肝炎表面抗體