Question: A 35-year-old woman presents for a follow-up. The patient was diagnosed with major depressive disorder 16 months ago and has tried multiple medications with no improvement, namely bupropion, fluoxetine, sertraline, and imipramine. Upon inquiry, she assures the psychiatrist that she has been fully compliant with her medications so far but stopped her current medications a few weeks back as they did not help either. Her husband suggested her to try a herbal preparation for improving her mood. She also noted that she felt temporarily better while attending her sister’s wedding last weekend, but she still remains depressed most of the times. Which of the following would be the next best step in the treatment of this patient’s depression?

Answer: Phenelzine

A. St John’s Wort

B. Selegiline

C. Phenelzine

D. Electroconvulsive therapy


Question: A 17-year-old boy is brought in by paramedics to the emergency department. He was found down at a family picnic. The boy's parents state that he tried many new foods at the picnic. Additionally, because it is springtime, many insects were out while he was playing football. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 33/min, and oxygen saturation is 84% on room air. Physical exam is notable for tachycardia and very minimal breath sounds bilaterally. No jugular venous distention is noted and an abdominal exam is within normal limits. Which of the following best describes an effect of the next best step in management?

Answer: Decreased serum potassium

A. Decreased serum potassium

B. Equilibration of environmental and chest cavity pressure

C. Hypoglycemia

D. Increased systemic vascular resistance


Question: A 45-year-old woman comes to the emergency department with her 17-year-old son because she believes she has been poisoned by her ex-husband. She reports that her coffee tasted “strange” this morning. After breakfast, she then saw a black car drive by the house, which she concludes must have been her ex-husband, who also drives a black car. She says that since the divorce 3 years ago, her ex-husband has been seeking revenge and thinks that he has installed cameras in her apartment to spy on her and their son. She has never seen any of these cameras but when she is alone in the apartment, she can sometimes hear them beeping and feel them recording her. The son also reports his mother's coffee mug smelled of bitter almonds, which he suspects was cyanide. He agrees with the mother's distrust towards his father and reports that he has also occasionally heard a camera beeping but has not been able to find any cameras yet. The mother's vital signs are within normal limits. Physical examination shows no abnormalities. Arterial blood gas analysis on room air shows a pH of 7.4. Toxicology screening is negative. Which of the following is the best initial step in management?

Answer: Examine mother and son separately

A. Ziprasidone therapy

B. Repetitive transcranial magnetic stimulation

C. Examine mother and son separately

D. Report the case to the authorities


Question: A 2-year-old boy is brought to the physician after his adoptive mother observed jerking movements of his arms and legs earlier that morning. He was adopted from an orphanage in Albania at 4 months of age. He has a history of intellectual disability. Examination shows pale skin and light blue eyes. There is a dry, eczematous, scaly rash on the extensor surfaces of the extremities. This patient is most likely deficient in which of the following enzymes?

Answer: Phenylalanine hydroxylase

A. Phenylalanine hydroxylase

B. α-ketoacid dehydrogenase

C. Cystathionine synthase

D. Homogentisate oxidase


Question: A 45-year-old man comes to the physician because of a 4-month history of increased frequency of urination. He wakes up several times a night to urinate and feels fatigued during the day. He also complains of increased thirst; he drinks multiple liters of water and soda daily and still feels thirsty. Vital signs are within normal limits. Physical examination shows patches of velvety hyperpigmentation in the axilla and on the posterior neck. Laboratory evaluation in this patient is most likely to show which of the following?

Answer: Elevated glycated hemoglobin concentration

A. Elevated serum thyroxine concentration

B. Elevated glycated hemoglobin concentration

C. Positive urinary leukocyte esterase

D. Low urine osmolality


Question: A 69-year-old man comes to the physician with a 9-month history of worsening shortness of breath on exertion and need to urinate at night. He occasionally has palpitations but does not have chest pain. The patient had a transient ischemic attack 5 years ago for which he underwent right-sided carotid endarterectomy. He has hypertension and type 2 diabetes mellitus. Current medications include metformin, lisinopril, aspirin, and simvastatin. He appears fatigued. His pulse is 61/min, blood pressure is 120/75 mmHg, and respirations are 25/min. Pulse oximetry shows an oxygen saturation of 96%. Examination shows cold extremities. There are no murmurs or rubs on cardiac auscultation. Fine, bilateral crackles are heard at the lung bases. There is 2+ lower extremity edema. An ECG shows sinus rhythm and known T wave inversions in leads V1 to V4. Which of the following agents is most likely to improve the patient's long-term survival?

Answer: Eplerenone

A. Eplerenone

B. Ivabradine

C. Verapamil

D. Digoxin


Question: A 22-year-old woman presents to her primary care provider complaining of a facial rash. She says the rash began 3 weeks ago after hiking in the White Mountains of New Hampshire this summer. Since that time she has also experienced pain in her hands and wrists that is worse in the morning and accompanied by subjective fevers. She denies chest pain, shortness of breath, nausea, or vomiting. Vital signs are 99.6°F (37.6°F), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min. Examination demonstrates a rash on the patient's face that spares the nasolabial folds along with oral ulcers. The metacarpophalangeal joints are tender to palpation, and range of motion is limited by pain. Complete blood count demonstrates normocytic anemia with thrombocytopenia. Which of the following is the next best step in diagnosis?

Answer: Anti-nuclear antibodies

A. Anti-cardiolipin antibodies

B. Anti-dsDNA antibodies

C. Anti-nuclear antibodies

D. Anti-Smith antibodies


Question: A 54-year-old man presents with fever and a painful jaw mass with a yellowish discharge. He says that he first noticed the jaw mass 6 weeks ago and that the mass has been progressively increasing in size. He reports a history of chronic alcoholism and currently takes more than 6 drinks daily. His temperature is 37.9°C (100.2°F). On physical examination, there is a 7 × 7 cm mass at the tip of the jaw bone with significant surrounding edema and sclerosis The mass is severely tender on light palpation and has a yellowish malodorous discharge. The oral cavity shows signs of very poor dentition. Laboratory analysis of the discharge reveals gram-positive anaerobic filamentous bacteria. Which of the following organisms is the most likely cause of this patient’s condition?

Answer: Actinomyces israelii

A. Peptostreptococcus magnus

B. Actinomyces israelii

C. Nocardia asteroides

D. Eikenella corrodens


Question: A 57-year-old homosexual man presents to the emergency department with epigastric pain. He has presented multiple times for the same complaint in the past. The patient has a past medical history of alcoholism and is homeless. He states that his symptoms at this time are constant and occur at all times of the day and are near his baseline. He also endorses fatty and foul smelling diarrhea during this time frame. Which of the following is the best initial diagnostic test for this patient’s condition?

Answer: CT scan

A. CT scan

B. Lipase

C. Secretin stimulation test

D. Stool ova and parasite analysis


Question: A 6-year-old boy is rushed to the emergency department after being involved in a motor vehicle accident. He has abrasions on his left knee and left elbow. His wounds are cleaned and a pressure bandage is applied. Typically, neutrophils and macrophages are attracted toward the site of injury by various chemical mediators. Which of the following cells is responsible for the initial cascade by the release of TGF-β and PDGF?

Answer: Platelets

A. Mast cells

B. Fibroblasts

C. Platelets

D. Basophils


Question: A 70-year-old man comes to the emergency department after briefly losing consciousness and collapsing when rising from a chair. He did not sustain any injuries from his collapse. He has had a two-week history of dizziness upon standing. He has smoked one pack of cigarettes daily for 55 years. He drinks three beers and two glasses of whiskey daily. He currently takes dutasteride and tamsulosin for benign prostatic hyperplasia. His blood pressure is 120/80 mm Hg supine and 100/70 mm Hg one minute after standing with no change in pulse rate. Physical examination shows conjunctival pallor. On cardiac auscultation, there is a plopping sound followed by a low-pitched, rumbling mid-diastolic murmur heard best at the apex. Which of the following is the most likely cause of this patient's presentation?

Answer: Cardiac tumor

A. Stokes-Adams attack

B. Constricted aortic valve orifice

C. Cardiac tumor

D. Left ventricular dilation


Question: A 6-month-old infant is brought to a pediatrician for his scheduled immunizations. The parents deny any specific current complaints, but his facial features differ from those of other children in the family. During the physical examination, the pediatrician notes that the infant’s vital signs are stable. His facial features include a medial epicanthic fold, a face that appears flat, and a flat occiput with low-set ears. The pediatrician also notes a single transverse palmar crease on both hands. An echocardiogram is performed which suggests that the infant has a congenital heart disease which is the most common form of congenital heart disease seen in children with this particular genetic disorder. Which of the following congenital heart diseases does this infant most likely present with?

Answer: Atrioventricular septal defect

A. Supravalvar aortic stenosis

B. Tetralogy of Fallot

C. Atrial septal defect

D. Atrioventricular septal defect


Question:
A 32-year-old white woman comes to the physician because of fatigue, lethargy, and swelling of the lower legs for 2 months. She reports recurrent episodes of pain in both wrists, her right knee, and her right ankle in the past year. She has had skin problems that are aggravated by exposure to sunlight for the past 18 months. She has smoked one pack of cigarettes daily for 13 years and drinks one alcoholic beverage daily. Her temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 115/75 mm Hg. Examination shows 2+ pretibial edema bilaterally and periorbital edema. There are erythematous patches with scaling on both cheeks. Laboratory studies show:
Hemoglobin 11.2 g/dL
Leukocyte count 8500/mm3
Platelet count 130,000/mm3
Serum
Urea nitrogen 36 mg/dL
Glucose 77 mg/dL
Creatinine 0.9 mg/dL
Albumin 2.6 mg/dL
Total cholesterol 275 mg/dL
Triglycerides 180 mg/dL
Urine
Blood negative
Glucose negative
Protein 4+
WBC 0–1/hpf
Fatty casts numerous
A renal biopsy specimen is most likely to show which of the following?"

Answer: Thickened capillary loops

A. Thickened capillary loops

B. Segmental sclerosis

C. Crescent formation

D. Hypercellular glomeruli


Question: A 60-year-old man presents to the clinic with his wife for “weird breathing” during the night. The patient’s wife says that his breathing pattern is irregular but he does not snore. The patient says he is not aware of these symptoms. Past medical history is remarkable for an NSTEMI when he was 50 years old. He spends a night at the sleep lab where his tidal volume is monitored overnight and a tracing is shown in the image below. Which of the following is most likely responsible for this patient’s breathing pattern?

Answer: Left ventricular heart failure

A. Diabetic ketoacidosis

B. Hypothyroidism

C. Left ventricular heart failure

D. Obesity


Question: A 72-year-old man with a history of chronic kidney disease presents to his primary care physician complaining of recurrent chest pain with activity. The patient used to have chest pain when he mowed his lawn. Now he gets chest pain whenever he walks short distances such as to get his mail. The pain resolves on its own when the patient sits and rests. His temperature is 98.2°F (36.8°C), blood pressure is 157/98 mm Hg, pulse is 80/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man who is in no distress. An initial ECG is unchanged from a previous ECG. The patient's first troponin is 0.06 ng/mL which is unchanged from previous troponins. Which of the following is the most likely diagnosis?

Answer: Unstable angina

A. NSTEMI

B. Stable angina

C. Unstable angina

D. Variant angina


Question: A 55-year-old woman presents to the surgical oncology clinic as a new patient for evaluation of recently diagnosed breast cancer. She has a medical history of hypertension for which she takes lisinopril. She denies any surgical history. Her family history is notable for breast cancer in her maternal grandmother. She is visibly anxious during the encounter, but physical examination is otherwise unremarkable. Her primary concern today is which surgical approach will be chosen to remove her breast cancer. Which of the following procedures involves the removal of an entire breast?

Answer: Mastectomy

A. Vasectomy

B. Mastectomy

C. Lumpectomy

D. Arthroplasty


Question: A 14-year-old female is seeing her pulmonologist in clinic after a recent asthma exacerbation. She has been adherent to her original controller medication so the physician prescribes an additional new drug which prevents IgE binding to mast cells. Which of the following did the physician add?

Answer: Omalizumab

A. Theophylline

B. Albuterol

C. Omalizumab

D. Beclamethasone


Question: A 24-year-old man is brought in to the emergency room after being retrieved by firefighters from a burning building. The patient is responding coherently to questions but reports pain secondary to a burn on his leg. He states he also has a headache and feels dizzy. His temperature is 98.5°F (36.9°C), blood pressure is 129/66 mmHg, pulse is 126/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused young man with dry and flushed skin. Cardiopulmonary exam reveals a normal S1 and S2 as well as clear breath sounds bilaterally. The patient’s neurological exam is within normal limits. Towards the end of his exam, the patient begins vomiting. Dermatologic exam reveals a superficial burn covering 1% of the patient’s body over his right leg. Which of the following is the best next step in management for this patient?

Answer: 100% oxygen

A. 100% oxygen

B. Hydroxocobalamin

C. Normal saline

D. Ondansetron


Question: A 29-year-old female presents to her psychiatrist with concerns that she may be "OCD." She explains that she has become extremely obsessed with making sure that her fruits and vegetables are completely sanitized by first rinsing with water for exactly 60 seconds and then boiling for exactly 60 minutes. She refuses to eat any fruits or vegetables that did not undergo this process, which she began doing about 3 months ago. Which of the following vitamin deficiencies is she most likely to develop?

Answer: Vitamin C

A. Vitamin A

B. Vitamin K

C. Vitamin C

D. Vitamin E


Question: A 73-year-old male is brought to his family practitioner by his daughter with the complaints of a spinning sensation for the past 4 weeks. He says that the room appears to be continuously spinning. This has progressively worsened over the last 4 weeks to the point that he has become bed bound and cannot walk without support. These spinning sensations are present throughout the day and do not change with position. They are associated with nausea and vomiting. He denies ear pain, ear discharge, ringing in the ear, hearing disturbances, ear fullness, head trauma, fever, or recent flu-like illness. He has a blood pressure of 133/80 mm Hg, heart rate of 80/min, respiratory rate of 12/min, and temperature of 36.7°C (98.2°F). His extraocular eye movements are normal in all directions, but a vertical nystagmus is present that does not disappear despite repetitive testing. Hearing tests are within normal limits. What is the most likely diagnosis?

Answer: Cerebellar tumor

A. Acute labyrinthitis

B. Benign paroxysmal positional vertigo

C. Cerebellar tumor

D. Meniere's disease


Question: A 79-year-old man presents to the emergency room after a syncopal event. The patient has a history of hyperlipidemia for which he is taking atorvastatin. On physical examination, his vital signs are stable, but on cardiac auscultation, you detect a crescendo-decrescendo systolic murmur loudest on the right upper sternal border radiating to the neck. On physical exam, one would also expect:

Answer: Palpation of the carotid pulse would be weak and late relative to the patient’s heart sounds

A. That the murmur would best be heard in the lateral left decubitus position

B. The character of the murmur would be machine-like

C. The murmur would also have a mid-systolic click loudest before S2

D. Palpation of the carotid pulse would be weak and late relative to the patient’s heart sounds


Question: A researcher is designing a study to examine a possible correlation between exposure to a particular pesticide and chronic bronchitis. The researcher gathers all records of patients presenting with bronchitis for the past 10 years from the local hospital and contacts the qualifying subjects to ask them about exposure to the particular pesticide. Using the data he compiles, he is able to calculate an estimate for the relative and absolute risk for developing chronic bronchitis in people who have been exposed to that pesticide. Which of the following best describes this type of study design?

Answer: Cross-sectional study

A. Case-control study

B. Cross-sectional study

C. Cohort study

D. Double-blind, randomized, placebo-controlled clinical trial


Question: A 49-year-old woman presents to her primary care physician due to fatigue and shortness of breath. She finds herself being short of breath when climbing the stairs or walking uphill. Approximately 1 year ago, she was able to partake in long-distance running and weightlifting. Two weeks ago she noticed blood-tinged sputum after severely coughing during sleep. She emigrated from Mexico to the United States 3 years ago. Her temperature is 98°F (36.7°C), blood pressure is 100/62 mmHg, pulse is 135/min and irregularly irregular, and respirations are 21/min. On physical exam her speech is hoarse. She has bilateral crackles heard in the lung bases. Which of the following will most likely be found on cardiac auscultation?

Answer: Opening snap with a mid-to-late diastolic murmur

A. Crescendo-decrescendo systolic ejection murmur

B. High-pitched, early diastolic decrescendo murmur

C. Holosystolic, high-pitched murmur loudest at the left lower sternal border

D. Opening snap with a mid-to-late diastolic murmur


Question:
A 60-year-old man presents to the physician for a follow-up examination. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound. He has no complaints other than fatigue for several months. He has no history of serious illness and takes no medications. The vital signs are within the normal range. On percussion, spleen size is 15 cm (5.9 in). Otherwise, the physical examination shows no abnormalities. The laboratory test results are as follows:
Hemoglobin 10 g/dL
Mean corpuscular volume 88 μm3
Leukocyte count 65,000/mm3
Platelet count 500,000/mm3
The peripheral blood smear shows a predominance of neutrophils and the presence of band cells, myelocytes, promyelocytes, and blasts (< 5%). The molecular studies document the BCR-ABL1 rearrangement. Which of the following is the most appropriate pharmacotherapy at this time?

Answer: Imatinib

A. All-trans retinoic acid

B. Aspirin

C. Imatinib

D. Hydroxyurea


Question: A 45-year-old man presents to the outpatient unit with a complaint of lower extremity edema for the past few weeks. He has also been observing puffiness of the face lately. The urinalysis shows 4+ proteinuria. The serum creatinine is 3.5 mg/dL, and antinuclear antibodies are absent. The biopsy findings are given in the picture. What is the most likely cause of the following findings?

Answer: Membranous glomerulonephritis

A. Membranoproliferative glomerulonephritis

B. Rapidly progressive glomerlonephritis

C. Postinfectious glomerulonephritis

D. Membranous glomerulonephritis


Question: A 2-year-old male is brought to his pediatrician by his parents because of a lack of testes in his scrotum. Physical examination confirms that testes are absent from the scrotal sac and palpable masses are found bilaterally around the inguinal canal. If the child’s condition is left untreated, levels of which of the following hormones is most likely to be decreased most when the child reaches sexual maturity?

Answer: Inhibin

A. FSH

B. LH

C. Inhibin

D. Prolactin


Question: A 23-year-old man presents to the emergency department by ambulance after being rescued from a burning house. The patient was intubated in the field and is maintaining his oxygen saturation above 98%. Physical exam reveals partial or full-thickness burns across an estimated 30% of his total body surface area. His weight is 70 kg. Which of the following is the volume of isotonic fluid that should be given to this patient over the next 24 hours?

Answer: 8,400 mL

A. 1,100 mL

B. 4,200 mL

C. 8,400 mL

D. 16,800 mL


Question: A 28-year-old G1P0 primigravida woman at 28 weeks estimated gestational age presents for routine prenatal care. She has no complaints and says she can feel her baby move and respond to outside sounds. The patient has no significant past medical or family history. Currently, she is taking a prenatal multivitamin which contains iron and folic acid. Her blood type is A (-) negative, and her husband is A (+) positive. The patient says she stopped drinking alcohol 2 years ago and denies any history of smoking or recreational drug use. Her pulse is 90/min, blood pressure is 114/68 mm Hg, and respiratory rate is 18/min. She has gained 9.0 kg (19.8 lb) over the course of the pregnancy. Physical examination shows a gravid uterus, extending 28 cm above the pubic symphysis. Occasional movements are observed in the abdomen. There is no guarding or tenderness to palpation. Fetal heart sounds can be auscultated. The remainder of the examination is unremarkable. The patient is administered an injection of RhO(D) immunoglobulin (RhoGAM). Which of the following statements best describes the rationale for administering RhO(D) immunoglobulins (RhoGAM) in this patient?

Answer: RhO(D) immunoglobulins will prevent anti-D antibody formation in the mother.

A. RhO(D) immunoglobulin will prevent hemolytic disease in this pregnancy.

B. The father requires RhO(D) immunoglobulin administration rather than the patient.

C. RhO(D) immunoglobulins will prevent anti-D antibody formation in the mother.

D. RhO(D) immunoglobulins will prevent anti-D antibody formation in the fetus.


Question: A 51-year-old man comes to the physician for evaluation of inability to attain an erection during sexual activity for 6 months. He has had an active sexual life in the past. He reports that early morning erections are present every other day. He has a history of hypertension and diabetes mellitus. His wife recently filed for divorce. He has smoked one pack of cigarettes daily for 25 years. His only medications are enalapril and metformin. Physical examination shows no abnormalities. The underlying cause of this patient's condition is best classified as which of the following?

Answer: Psychogenic

A. Hormonal

B. Neurogenic

C. Psychogenic

D. Vascular


Question: A 49-year-old G4P4 woman comes to the clinic complaining of repeated leakage of fluid from her vagina for the past 5 months. She noticed an increase in episodes following her cold last week when she was coughing and sneezing a lot. Her past medical history is significant for Crohn disease, which is well controlled with sulfasalazine. Her last menstrual period was 1 year ago. She is currently sexually active with multiple partners with inconsistent condom use. She denies any vaginal itching, abnormal discharge, pain, subpubic pressure, urinary urges, or odors. Physical examination is significant for a bulge at the anterior vaginal wall. What is the most likely explanation for this patient’s symptoms?

Answer: Prolapse of the bladder

A. Prolapse of the bladder

B. Detrusor muscle overactivity

C. Genitourinary syndrome of menopause

D. Rectovaginal fistula


Question: A 24-year-old woman presents to a physician with recurrent episodes of palpitations, shortness of breath, and perspiration. The episodes are self-limited and are usually preceded by specific social circumstances that she does not enjoy. There is no significant past medical history. After a complete history and physical examination, the physician diagnoses an anxiety disorder. He explains that anxiety is associated with the stimulation of the sympathetic nervous system which produces several symptoms related to anxiety such as tachycardia. Which of the following cellular mechanisms best explains the effects of stimulation of sympathetic cardiac nerves on the pacemaker cells in the sinoatrial node?

Answer: Facilitation of If currents through HCN channels

A. Decreased intracellular cyclic adenosine monophosphate (cAMP) level in the sinoatrial node

B. Inactivation of L-type voltage-gated calcium channels

C. Facilitation of If currents through HCN channels

D. Opening of G-protein activated potassium channels


Question:
A 14-year-old boy is brought to the office by his parents because he states that for the past 2 months he has been feeling constantly tired, and also noticed a dull pain in the pit of his stomach. The patient has no relevant family history. The vital signs include a heart rate of 105/min, a respiratory rate of 16/min, a temperature of 37.0°C (98.6°F), and a blood pressure of 111/66 mm Hg. On physical exam, the abdomen is distended with hepatomegaly 5 cm underneath the xiphoid process. The complete blood count results are as follows:
Hemoglobin 17.6 g/dL
Hematocrit 64%
RBC 6.02 x 1012/L
Leukocyte count
26,300/mm3
Neutrophils 55%
Bands 2%
Eosinophils 1%
Basophils 0%
Lymphocytes 29%
Monocytes 2%
Platelet count 480,000/mm³
Erythropoietin < 1.0 mU/mL
The coagulation test results are as follows:
Partial thromboplastin time (activated) 30.9 s
Prothrombin time 14.0 s
The abdominal Doppler ultrasound imaging is shown in the picture. What is the most likely etiology of this patient’s diagnosis?

Answer: Polycythemia vera

A. Behçet's syndrome

B. Protein C deficiency

C. Factor V Leiden mutation

D. Polycythemia vera


Question: A 17-year-old girl is presented to the clinic by her mom for hair loss. Both the girl and her mom have noted random patches of hair loss across the girl's scalp, eyebrows, and eyelashes, 1st appearing several months ago. The girl has noticed no other symptoms, though the spots of hair loss are sometimes sore. On further questioning, the girl shares that she has been very stressed lately about getting good grades and applying to colleges. She knows she needs to do well on all of her homework in order to get into a good college, so she has sometimes had to stay up late into the night to rewrite her homework over and over again so that they are 'absolutely perfect'. The physical exam shows an anxious-appearing, somewhat quiet girl. There is diffuse hair loss and thinning across her scalp, with many different hair shafts of different lengths. There is no discernible pattern to the hair loss. Which of the following is the best treatment for this patient?

Answer: Cognitive-behavioral therapy

A. Cognitive-behavioral therapy

B. Intralesional steroids

C. Oral griseofulvin

D. Systemic steroids


Question: In a town with a hepatitis B prevalence of 4%, a new screening test is introduced as part of a study. The first round of the study detects cases of hepatitis B using the new test, which has a sensitivity of 99% and a specificity of 77%. In the second round of the study, the same test is used again in a different population with a hepatitis B prevalence of 29%. Which of the following best describes the findings obtained from the study?

Answer: The positive predictive value would increase in the second round.

A. The positive predictive value would increase in the second round.

B. The sensitivity would decrease in the second round.

C. The negative predictive value would increase in the second round.

D. The positive likelihood ratio would increase in the second round.


Question: A 5-year-old girl is brought to the physician for a well-child examination. Her mother says she has been having trouble sleeping for 3 weeks because of pruritus in her genital area. The girl has otherwise been feeling well. She is at the 45th percentile for height and 51st percentile for weight. Vital signs are within normal limits. Pelvic examination shows erythema of the vulva and perianal region. There is no vaginal discharge. Which of the following is the most appropriate next step in management?

Answer: Perianal cellophane-tape examination

A. Potassium hydroxide preparation

B. Perianal cellophane-tape examination

C. Cultures for chlamydia and gonorrhea

D. Stool microscopy


Question: A 25-year-old man comes to the emergency department because of left flank pain for 2 hours. The pain is colicky in nature and he describes it as 8 out of 10 in intensity. He has nausea and has vomited once. He had a similar episode 6 months ago for which he took naproxen. There is no personal or family history of serious illness. He is a second-year medical student and has been consuming more coffee and energy drinks than normal to stay awake and study for the past 2 days. He does not smoke or drink alcohol. He takes no medications. His temperature is 37.3°C (99.1°F), pulse is 98/min, and blood pressure is 124/78 mm Hg. The abdomen is soft and nontender. Examination of the back shows no costovertebral angle tenderness. The remainder of the examination shows no abnormalities. Urinalysis is unremarkable. Which of the following is the most likely underlying cause of this patient's symptoms?

Answer: Ureteropelvic junction obstruction

A. Bilateral renal cysts

B. Glomerular IgA deposits

C. Ureteropelvic junction obstruction

D.
Ascending urinary tract infection
"


Question: An otherwise healthy 6-year-old boy presents for a follow-up visit to his pediatrician's office for persistent nocturnal enuresis. He has never been dry at night and throughout the last year the pediatrician has seen him multiple times for this issue. He and his family have tried not drinking liquids 2 hours before bed, bed wetting alarms, and a reward sticker chart with limited success. His 2 older brothers had nocturnal enuresis that resolved on its own when they were 8 years of age, but the patient often sleeps over at a friend's house and is very bothered by this problem. He has 1 soft stool a day, denies abdominal pain, dysuria, or frequency, and has been continent during the day since 3 years of age. He has a completely normal physical exam, urinalysis, and basic metabolic panel. What is the next best step in management?

Answer: Desmopressin

A. Cognitive behavioral therapy

B. Desmopressin

C. Imipramine

D. Oxybutynin


Question: A 41-year-old woman presents with acute right flank pain for the past 6 hours. She says the pain is severe, colicky, ‘comes in waves’, and is localized to the right flank. She also has associated nausea and vomiting. The patient is afebrile, and her vital signs are within normal limits. On physical examination, she is writhing in pain and moaning. There is severe right costovertebral angle tenderness. Gross hematuria is present on urinalysis. A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone obstructing the right ureteropelvic junction. Aggressive IV fluid hydration is started, and ondansetron is administered. Which of the following is the next best step in the management of this patient?

Answer: Hydrocodone/acetaminophen

A. Renal ultrasound

B. 24-hour urine chemistry

C. Potassium citrate

D. Hydrocodone/acetaminophen


Question: A 36-year-old female presents with a 6-month history of stiffness in her joints. She reports bilateral knee pain that is worse in the morning prior to activity and stiffness of the fingers in both hands. Anti-CCP antibody tests are positive. Over several months, the patient's symptoms prove unresponsive to NSAIDs and methotrexate, and the decision is made to begin infliximab. Which of the following drugs has the most similar mechanism to inflixmab?

Answer: Trastuzumab

A. Imatinib

B. Cyclophosphamide

C. Trastuzumab

D. Allopurinol


Question: A 55-year-old man presents to the emergency department with chest pain that started 1 hour ago and has not been improving. He has a past medical history of diabetes, hypertension, and obesity. His temperature is 98.5°F (36.9°C), blood pressure is 147/68 mmHg, pulse is 130/min, respirations are 13/min, and oxygen saturation is 100% on room air. Physical exam is notable for jugular venous distension and bilateral lower extremity pitting edema. The patient is given nitroglycerin, and his chest pain improves. Which of the following is the best explanation for this patient’s improvement in symptoms?

Answer: Preload reduction

A. Coronary artery vasodilation

B. Decreased adrenergic tone

C. Mu receptor agonism

D. Preload reduction


Question: An investigator is studying energy metabolism in athletes. Baseline serum lactate levels at rest are recorded and repeat levels are obtained directly after a 1000-meter sprint. Compared to the baseline measurements, the serum lactate levels are significantly increased after the sprint. This increase in serum lactate is necessary to regenerate an essential cofactor for which of the following enzymes?

Answer: Glyceraldehyde-3 phosphate dehydrogenase

A. Glycogen phosphorylase

B. Glyceraldehyde-3 phosphate dehydrogenase

C. Phosphofructokinase-1

D. Pyruvate carboxylase


Question: A scientist is studying the development of CD8+ T cells. In his experiments, he uses a radioactive isotope to mark a population of T cells. Once injected into the thymus, these cells bind tightly to MHC I self-antigen complexes. Later in the experiment, the scientist cannot find any marked cells in the peripheral blood. Which of the following processes is responsible for the loss of these marked CD8+ cells?

Answer: Negative selection

A. Positive selection

B. Negative selection

C. APC antigen presentation

D. IL-2 stimulation


Question: A 65-year-old woman who has smoked 2 packs per day for forty years comes to your practice complaining of a chronic cough, dyspnea, hemoptysis, and difficulty rising from a chair. Based on CXR and biopsy slides shown, you feel that all of the following would be consistent with her diagnosis EXCEPT?

Answer: Decreasing muscle strength with repetitive stimulation

A. Decreasing muscle strength with repetitive stimulation

B. Antibodies to presynaptic calcium channels

C. Dry mouth

D. Orthostatic hypotension


Question: A 16-month-old boy is brought to the pediatrician after his parents noticed the appearance of a rash on his face, torso, and limbs. The boy has been ill for almost 2 weeks, initiating with fever, malaise, coryza, headache, nausea, diarrhea, and a rash on both of his cheeks. Physical examination is unremarkable except for an erythematous maculopapular rash on the face, trunk, and extremities with a reticular pattern (as shown in the photograph). What is the most likely diagnosis?

Answer: Erythema infectiosum

A. Measles

B. Chickenpox

C. Erythema infectiosum

D. Roseola infantum


Question: A 27-year-old woman presents to a neurologist complaining of facial pain. She reports that over the past 6 months, she has developed intermittent burning unilateral facial pain that happens over 10 seconds to 3 minutes. The pain is severe enough to completely stop her from her activities. She is worried whenever she goes out that another attack will happen and she is sad that this has limited her ability to work as a lawyer. Her past medical history is notable for irritable bowel syndrome and polycystic ovarian syndrome. She takes an oral contraceptive pill. Her temperature is 98.6°F (37°C), blood pressure is 130/75 mmHg, pulse is 75/min, and respirations are 18/min. On exam, she is a well-appearing woman who is alert, oriented, and appropriately interactive. Her pupils are 2 mm and reactive to light bilaterally. Fundoscopic examination is unremarkable. Her strength and range of motion are full and symmetric in her upper and lower extremities. This patient’s symptoms are likely due to irritation of a nerve that passes through which of the following foramina?

Answer: Foramen rotundum

A. Foramen rotundum

B. Inferior orbital fissure

C. Jugular foramen

D. Superior orbital fissure


Question: A 26-year-old man comes to the physician because of high-grade fever, fatigue, nausea, and headache for 4 days. The headache is constant and feels like a tight band around his head. He also reports that his eyes hurt while looking at bright lights. He has been taking acetaminophen and using cold towels to help relieve his symptoms. He works as an assistant for a nature camp organization but has been unable to go to work for 3 days. His immunization records are unavailable. His temperature is 38.5°C (101.3°F), pulse is 92/min, and blood pressure is 108/74 mm Hg. He is oriented to time, place, and person. There is no rash or lymphadenopathy. Flexion of the neck results in flexion of the knee and hip. A lumbar puncture is done; cerebrospinal fluid analysis shows an opening pressure of 80 mm H2O, leukocyte count of 93/mm3 (78% lymphocytes), a glucose concentration of 64 mg/dL, and a protein concentration of 50 mg/dL. Which of the following is the most likely causal organism?

Answer: Coxsackievirus

A. Borrelia burgdorferi

B. Mycobacterium tuberculosis

C. Herpes simplex virus 1

D. Coxsackievirus


Question: A 4-year-old girl presents to the pediatrician’s office for a physical examination prior to starting preschool. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. She takes no medications but does take a chewable vitamin daily. She lives with her parents and older brother in a house. Today, her blood pressure is 110/65 mm Hg, heart rate is 90/min, respiratory rate is 22/min, and temperature of 37.0°C (98.6°F). On physical exam, she appears well developed and pleasant. She sits listening to the conversation and follows directions. Palpation of the heart reveals a mild parasternal heave. Auscultation reveals a normal S1 but the S2 is split and remains split during inhalation and exhalation. Additionally, there is a medium pitched midsystolic murmur that is loudest between ribs 2 and 3 on the left side and a very soft diastolic rumble. Which of the following congenital defects is the most likely cause of these findings?

Answer: Atrial septal defect

A. Atrial septal defect

B. Coarctation of the aorta

C. Patent ductus arteriosus

D. Tetralogy of Fallot


Question: A 24-year-old man is brought to the emergency department after his head was hit with a bat during a baseball game. His teammates state that he was unresponsive after the incident but regained consciousness after 15 minutes. The patient initially refused to go to the hospital and sat on the bench for the remainder of the game. He initially appeared fine but became increasingly confused. He appears lethargic but opens his eyes to loud verbal commands. He is oriented to person and place. His temperature is 37.1 (98.8°F), pulse is 78/min, respiratory rate is 16/min, and blood pressure is 148/87 mm Hg. Examination shows an area of soft-tissue swelling over the left temporal region. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. A CT scan of the head is shown. After returning from the CT scan, the patient only opens his eyes to painful stimuli and responds to questions with incomprehensible sounds. He withdraws from painful stimuli. On repeat examination, the left pupil is 6 mm in diameter and reacts minimally to light. The right pupil is 3 mm in diameter and reacts normally to light. His respiratory rate is 10/min and he is intubated in the emergency department. Which of the following is the most appropriate next step in management?

Answer: Perform craniotomy

A. Adminster hypotonic saline

B. Administer dexamethasone

C. Perform craniotomy

D. Perform brain MRI


Question:
A 58-year-old woman comes to the physician for a routine follow-up examination. She has a history of type 2 diabetes mellitus, hypertension, and asthma. Last year, she received laser photocoagulation for proliferative retinopathy. Her current medications include metformin, lisinopril, and an albuterol inhaler. Her mother died of complications from diabetes. She drinks 1 glass of wine daily with dinner and does not smoke. Her temperature is 37.2°C (99°F), pulse is 92/min, respirations are 14/min, and blood pressure is 152/98 mm Hg. Cardiopulmonary examination is unremarkable. There is decreased sensation to monofilament testing of the plantar surfaces of both feet. Laboratory studies show:
Today 6 months ago
Hemoglobin A1c 6.2% 6.4%
Serum
Creatinine 1.3 mg/dL 1.1 mg/dL
Urine
Albumin:creatinine ratio (N < 30) 470 mg/g 260 mg/g
The addition of which of the following medications is most likely to have prevented this patient's progressively worsening renal function?"

Answer: Amlodipine

A. Losartan

B. Aspirin

C. Atorvastatin

D. Amlodipine


Question: A 4-year-old boy is brought to the physician by his mother because of a rash on his hands and feet for the past two weeks. It is intensely pruritic, especially at night. He has not had fever, headache, or diarrhea. His mother has a history of eczema. The child was due for an appointment later in the week to follow up on any potentially missing vaccinations. His temperature is 37.8°C (100.1°F). Examination shows a maculopapular rash with linear patterns affecting the interdigital spaces of the fingers and toes. The remainder of the examination shows no abnormalities. Which of the following is the most effective intervention for this patient's skin lesion?

Answer: Topical permethrin

A. Oral acyclovir

B. Supportive care

C. Topical permethrin

D. Topical clotrimazole


Question: A 32-year-old man comes with his wife to the primary care physician because she is concerned about his drinking behavior. Specifically, he drinks 7 drinks every day and has abandoned many social activities that he previously enjoyed. In addition, he starts drinking in the morning because he feels shaky when he does not have a drink. When asked about his behavior, the man says that he knows that he probably should drink less but feels that he is not motivated enough to change. He says that perhaps the topic should be addressed again next year. Which of the following stages does this patient's behavior most likely represent?

Answer: Contemplation

A. Contemplation

B. Precontemplation

C. Preparation

D. Relapse


Question: An 18-month-old boy is brought to the emergency department 25 minutes after an episode of loss of consciousness. The child began crying after his 4-year-old brother snatched a toy from him. The brief shrill cry was followed by a period of expiration; he then turned blue, became unconscious, and briefly lost his muscle tone, before he stiffened and had jerky movements of his arms and legs for 15 seconds. After this episode, he immediately regained consciousness. He had a similar episode 2 weeks ago when his father refused to give him a juice box. He has been healthy and has met all his developmental milestones. Vital signs are within normal limits. He is alert and active. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management?

Answer: Reassurance

A. CT scan of the head

B. Echocardiography

C. Reassurance

D. Tilt table test


Question: A 67-year-old woman presents to the ophthalmologist with complaints of worsening visual loss. She states that her vision is blurry. Driving has become difficult, particularly at night, as she experiences substantial glare and sees halos around lights. On physical examination, there is absence of a red reflex. What is the most likely cause of this patient’s visual loss?

Answer: Cataracts

A. Age-related macular degeneration

B. Cataracts

C. Open-angle glaucoma

D. Refractive error


Question: A 30-year-old woman comes to the physician because of headaches and nausea for the past 3 weeks. The headaches are holocranial and last up to several hours. During this period, she has also had a swishing sound in both ears, which decreases when she turns her head to either side. She has had multiple episodes of blurring of vision and double vision for the past 2 weeks. She has vomited twice in the past week. She has nodular cystic acne and polycystic ovarian disease. Current medications include an oral contraceptive, metformin, and isotretinoin. She is 163 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 33.5 kg/m2. Her temperature is 37.3°C (99.1°F), pulse is 70/min, and blood pressure is 128/82 mm Hg. She is oriented to time, place, and person. Examination shows acne over her cheeks and back. Hirsutism is present. Visual acuity is 20/20 in both eyes. There is esotropia of the left eye. Further evaluation of this patient is most likely to show which of the following findings?

Answer: Bilateral optic disc swelling

A. Hyperpigmentation of palmar creases

B. Bilateral optic disc swelling

C. Raised intra-ocular pressure

D. Weakness of left upper and lower extremities


Question: A 64-year-old woman with knee osteoarthritis comes to the physician for a follow-up examination. She reports significantly improved pain control since starting celecoxib 1 month ago. A history involving which of the following conditions is most likely to explain the administration of this drug instead of another nonsteroidal anti-inflammatory drug?

Answer: Glanzmann thrombasthenia

A. Reye syndrome

B. Sulfa drug allergy

C. Glanzmann thrombasthenia

D. Gout


Question: A 48-year-old woman is admitted to the hospital and requires anticoagulation. She is administered a drug that binds tightly to antithrombin III. Which of the following drugs was administered?

Answer: Enoxaparin

A. Aspirin

B. Warfarin

C. Dabigatran

D. Enoxaparin


Question: A 20-year-old woman comes to the physician because of a 2-day history of low-grade fever and painful lesions on her left index finger. Two weeks ago, she had a painful rash on the right labia majora that resolved without treatment. Physical examination shows tender lymphadenopathy of the left epitrochlear and right inguinal region. A photograph of the left index finger is shown. Which of the following best describes the properties of the most likely virus involved?

Answer: Enveloped virus with a double-stranded, linear DNA structure

A. Naked virus with a double-stranded, circular DNA structure

B. Naked virus with a single-stranded, positive sense, linear RNA structure

C. Enveloped virus with a double-stranded, linear DNA structure

D. Enveloped virus with a partially double-stranded, circular DNA structure


Question: A 37-year-old man comes to the emergency department because of unsteady gait that started after waking up that morning. He has no fever, chills, headache, or myalgia. He works as a logger in Washington. His younger sister has multiple sclerosis. The patient appears pale. He is alert and responsive. His temperature is 37°C (98.9°F), pulse is 100/min, respirations are 11/min, and blood pressure is 136/86 mm Hg. Examinations shows intact cranial nerves. There is bilateral flaccid paralysis of his lower extremities. Lower extremity deep tendon reflexes are absent. The patient develops tachypnea and is admitted to the intensive care unit. Assisted breathing is started because of respiratory weakness. Which of the following is the most appropriate next step in management?

Answer: Locate and remove tick

A. Perform enzyme‑linked immunosorbent assay

B. Administer doxycycline

C. Administer botulism antitoxin

D. Locate and remove tick


Question: A 43-year-old man presents requesting a sleep aid for long-standing insomnia. He says he has been having trouble falling asleep for as long as he can remember, but it has become increasingly worse after he and his wife moved to their new house. He claims that his new neighbors are jealous of his huge swimming pool and are trying to sabotage it while he sleeps. His wife even had to cancel the housewarming party that was planned for the neighbors because of her husband’s behavior. When probed further on this topic, the patient accuses the physician of being angry and hostile. What is the next best step in the management of this patient?

Answer: Respond in a straightforward manner, be honest and non-threatening

A. Respond in a straightforward manner, be honest and non-threatening

B. Encourage the patient to inform the police

C. Set rules and be firm with adhering to them

D. Refer this patient to another physician


Question: A 22-year-old man presents to the emergency room after an altercation with the police. The police were called because the man was acting erratically in public. On physical examination, the patient is disoriented, does not respond to questioning, and appears to be reacting to internal stimuli. Laboratory tests are performed, which are all within normal limits, including a toxicology screen. The patient becomes aggressive and is given a medication to address his acute psychotic episode. An hour later, he is found in a sustained rigid posture in his bed, with his eyes in a fixed upward gaze. Which of the following medications was most likely given to this patient?

Answer: Haloperidol

A. Citalopram

B. Haloperidol

C. Phenelzine

D. Alprazolam


Question: A 42-year-old man is brought to the emergency department by his wife with chills and a temperature of 38.5°C (101.3°F) for the past 2 days. The patient’s wife mentions that he recently injured his leg 5 days ago, after which she noticed that his calf was swollen, red, and painful. She says there was no pus, but that her husband was in excruciating pain. His vital signs include: temperature 38.9°C (102.1°F), blood pressure 110/75 mm Hg, and  respiratory rate 18/min. On physical examination, there is a tender mass over the left calf which is red and inflamed. Blood and wound cultures are taken. The patient is started on empiric antibiotics with vancomycin, but shows no improvement. Culture results reveal that the causative organism is resistant to the current antibiotic as well as penicillin. Which of the following antibiotic therapies would be most suitable for this patient?

Answer: IV daptomycin

A. IV nafcillin

B. Dicloxacillin

C. IV daptomycin

D. Doxycycline


Question: A 63-year-old man presents to the emergency department with the sudden onset of excruciating chest pain, which he describes as a tearing sensation. He was diagnosed with essential hypertension 20 years ago, but he is not compliant with his medications. On physical examination, the temperature is 37.1°C (98.8°F), heart rate is 95/min, and blood pressure is 195/90 mm Hg in the right arm and 160/80 mm Hg in the left arm. The pulses are absent in his right leg and diminished in his left leg. A chest X-ray shows a widened mediastinum. Which of the following is the next best step?

Answer: CT scan

A. CT scan

B. Surgery

C. D-dimer

D. Intravenous ultrasound


Question: 在病人接受全身麻醉施行胸腰脊椎側彎（scoliosis）矯正手術時，下列何方法對脊椎神經功能監測最可靠？

Answer: wake-up test

A. motor evoked potentials

B. somato-sensory evoked potentials

C. electromyography

D. wake-up test


Question: 人體站立時，肺部那一區域的換氣／灌流比（ventilation/perfusion）為最高？

Answer: 肺尖

A. 肺底

B. 肺尖

C. 肺中央處

D. 肺各處均有相若之換氣／灌流比


Question: 一位 75 歲的男性，主訴最近 6 個月來快走會有心悸和胸悶的現象，身體檢查時，血壓 140/50 mmHg，心跳規律，胸骨右側上方可聽到心舒期雜音，心臟超音波檢查有嚴重的主動脈瓣逆流，但左心室收縮內徑（left ventricular end systolic dimension）為 58 mm，舒張內徑為 80 mm，此時最好的治療方式為何？

Answer: 用豬心瓣膜置換主動脈瓣

A. 用金屬性瓣膜置換主動脈瓣

B. 用豬心瓣膜置換主動脈瓣

C. 使用抗心律不整藥劑

D. 使用抗心衰竭藥劑


Question: 關於停經後的荷爾蒙療法，下列敘述何者錯誤？

Answer: 女性荷爾蒙有降低 LDL 的效果，所以可用於預防心血管疾病

A. 對於萎縮性陰道炎，可使用局部荷爾蒙療法

B. 女性荷爾蒙有降低 LDL 的效果，所以可用於預防心血管疾病

C. 荷爾蒙療法對於骨質疏鬆所造成的骨折有預防的效果

D. 若子宮未切除，使用女性荷爾蒙者需合併服用黃體素


Question: 下列何者不是路易氏體失智症（dementia with Lewy bodies, DLB）的主要症狀？

Answer: 舞蹈症

A. 認知功能時好時壞

B. 視幻覺

C. 舞蹈症

D. 巴金森氏症狀


Question: 「動作單位（motor unit）」指的是：

Answer: 單一運動神經元加上它支配的所有肌肉纖維

A. 單一運動神經元加上它支配的所有肌肉纖維

B. 一條肌肉纖維加上所有支配它的動作神經元

C. 供應單一肌肉的所有動作神經元

D. 一組拮抗肌群


Question: 下列何者並非神經內分泌瘤的組織免疫標記？

Answer: CD7

A. neuron-specific enolase

B. synaptophysin

C. chromogranin A

D. CD7


Question: 左側第九到十一後肋間靜脈血直接回流入下列何者？

Answer: 半奇靜脈（hemiazygos vein）

A. 奇靜脈（azygos vein）

B. 半奇靜脈（hemiazygos vein）

C. 左鎖骨下靜脈（left subclavian vein）

D. 內胸靜脈（internal thoracic vein）


Question: 利用配對方式選擇病例對照研究，下列何者錯誤？

Answer: 無法控制配對因子之干擾作用

A. 需事先決定干擾因子

B. 可降低已知干擾因子的影響

C. 無法控制配對因子之干擾作用

D. 需做配對分析


Question: 24 此時下列那些治療方式對此男嬰有幫助？①Blalock-Taussig 分流術 ②心房中隔氣球造口術（balloon atrial septostomy） ③前列腺素靜脈注射（PGE1 infusion） ④肺動脈環縮術（PA banding）

Answer: ②③

A. ①②

B. ②③

C. ①③

D. ①④


Question: 39 一位 55 歲停經後女性，發現乳房右側有一 2.5 公分腫塊，經詳細檢查後，接受改良型全乳房根除術 （modified radical mastectomy），病理診斷為乳癌（T2N0M0）, ER(+), PR(+), Her2(-)。術後輔助治療何者適當？

Answer: 荷爾蒙拮抗治療

A. 化學治療

B. 荷爾蒙拮抗治療

C. 化學治療合併放射治療

D. 放射治療


Question: 73.32歲男性病人右下腹痛2天，來到急診，身體檢查有明顯局部壓痛，白血球在正常值內但略偏高，C-reactive  protein上升。未注射顯影劑的電腦斷層如圖示，下列何項診斷最有可能？

Answer: epiploic appendagitis

A. epiploic appendagitis

B. acute ileus

C. ascending colon intusussception

D. colon cancer with perforation


Question: 一位60歲男性因突然大量吐血而被送至急診，呈休克狀態，經緊急輸液治療後，病情改進。發病前並未喝酒及嘔吐，也沒有服用非類固醇消炎止痛藥（NSAID, non-steroidal anti-inflammatory drugs），最近也無特殊壓力。他是B型肝炎病毒慢性感染者。這位病人最可能是下列那種病灶出血？

Answer: 食道靜脈曲張破裂出血

A. 食道靜脈曲張破裂出血

B. 胃癌出血

C. 出血性胃炎

D. 十二指腸第二部分出血


Question: 一位 2 歲的小孩，2 天前出現輕度發燒及皮膚病灶，並注意到全身出現紅斑，檢查時 Nikolsky sign 呈陽性，下列敘述何者正確？

Answer: 葡萄球菌皮膚燙傷樣症候群（staphylococcal scalded skin syndrome）為可能診斷

A. 葡萄球菌皮膚燙傷樣症候群（staphylococcal scalded skin syndrome）為可能診斷

B. 一定會侵犯黏膜組織

C. 使用類固醇治療有良好療效

D. 會留下永遠的皮膚病灶


Question: 一位50歲男性主訴胸部不適與行動時氣促，無高血壓病史，血壓130/80 mmHg，心跳規則每分鐘76次，聽診上有第四心音，但並無明顯雜音，胸部X光片無明顯異常，心電圖呈現左心室肥厚合併ST-T波變化，而心臟超音波呈現嚴重左心尖部肥厚與正常左心室收縮功能。下列何種藥物最不適當？

Answer: digitalis

A. digitalis

B. beta blockers

C. diltiazem

D. verapamil


Question: 一位 50 歲男性病人，因為皮膚出現紅疹且有劇癢來診，病人無發燒。三天前因為被診斷出有甲狀腺功能亢進，目前正服用抗甲狀腺藥物中。病人之白血球數為 4,500/μL，最適當的處置為下列那一項？

Answer: 給予抗組織胺、換用另外一種抗甲狀腺藥物

A. 立即停用抗甲狀腺藥物、建議開刀

B. 給予抗組織胺、換用另外一種抗甲狀腺藥物

C. 加入大量類固醇、立即安排放射性碘治療

D. 加入抗生素、給予 Lugol's solution


Question:
30.一位45歲自小罹患慢性B型肝炎的男性病患，主訴一個多月前覺得右上腹疼痛，有時疼痛會延伸到右邊的肩 膀。最近一週至門診追蹤腹部超音波顯示有多顆肝臟腫瘤，分別是一顆2.2公分大小在S2的位置，和另一顆6.6
 公分大小在 S5的位置，有觀察到低迴音（hypoechoic）的腫塊。進一步安排腹部電腦斷層之後，發現在相同位置有同樣大小的腫塊，並且已經侵犯到右側肝門靜脈。其他部位的腹部超音波和電腦斷層結果皆屬正常。抽血結果發現胎兒蛋白值（AFP）為230 ng/mL，AST 53 U/L，ALT 68 U/L。則這位病人最可能的診斷為何？

Answer: hepatocellular carcinoma with portal vein thrombosis

A. liver abscess with necrosis

B. hepatocellular carcinoma with portal vein thrombosis

C. multiple cavernous hemangioma

D. acute-on-chronic hepatitis


Question: 關於先天性肺部呼吸道畸形（congenital pulmonary airway malformation）的治療，下列何者比較正確？

Answer: 新生兒胸部X光發現右上肺葉有大囊泡狀病灶，出生後即因呼吸衰竭插管治療，應緊急進行開胸手術

A. 新生兒胸部X光發現右上肺葉有大囊泡狀病灶，出生後即因呼吸衰竭插管治療，應緊急進行開胸手術

B. 新生兒產前懷疑右下肺葉有實質狀病灶，出生後呼吸平穩，應立即接受肺部電腦斷層檢查

C. 新生兒產前懷疑左上肺葉有小囊泡狀病灶，於出生後6個月大時接受電腦斷層確診，應於2歲之後再手術

D. 3個月大男嬰因呼吸急促，經X光及電腦斷層檢查發現左下肺葉多囊泡狀病灶，應安排磁振造影（MRI）確定血管走向


Question: 王先生，56 歲農夫，有長期吸菸與嚼檳榔習慣，近 1 個月有喉嚨異物感、吞嚥不適、左耳疼痛、左前頸部腫大、雙側頸部中段各有一顆最大徑超過 2 公分腫瘤，聲音稍啞但無呼吸困難，經醫師檢查後可能的診斷是罹患下咽癌，王先生此時之臨床分期應該是多少？

Answer: T4N2c

A. T3N2a

B. T3N2b

C. T4N2b

D. T4N2c


Question: 36 26 歲不孕女性，主訴月經稀少，經檢查如圖 A、圖 B、圖 C 所示，欲治療圖 A 所呈現疾患，下列藥物何者最不適當？  圖 A：多毛  	 圖 B：後頸黑色素棘皮症 	圖 C：陰道超音波

Answer: danazol

A. medroxyprogesterone acetate

B. antiandrogen

C. 5α-reductase inhibitor

D. danazol


Question: 下列有關人體寄生蟲成蟲形態的敘述，何者錯誤？

Answer: 廣節裂頭絛蟲（Diphyllobothrium latum）具有圓形吸盤（sucker）

A. 十二指腸鉤蟲（Ancylostoma duodenale）具有兩對齒鉤

B. 蟯蟲（Enterobius vermicularis）具有頭翼（cephalic alae）

C. 牛羊肝吸蟲（Fasciola hepatica）具有頭錐（cephalic cone）

D. 廣節裂頭絛蟲（Diphyllobothrium latum）具有圓形吸盤（sucker）


Question: 傳染登⾰熱的病媒蚊是下列何者？

Answer: 埃及斑蚊、⽩線斑蚊

A. 熱帶家蚊、⽩腹叢蚊

B. 埃及斑蚊、⽩線斑蚊

C. ⽩腹叢蚊、⼩⿊蚊

D. 中華瘧蚊、熱帶家蚊


Question: 核子醫學 technetium pertechnetate scan 對診斷下列何種疾病有幫助？

Answer: 梅克耳憩室（Meckel's diverticulum）

A. 梅克耳憩室（Meckel's diverticulum）

B. 水腎

C. 骨髓病變

D. 腎上腺腫瘤


Question: 下列各病症與其病原蟲之配對中，何者錯誤？

Answer: Megaesophagus－杜氏利什曼原蟲（Leishmania donovani）

A. Romaña's sign－枯西氏錐蟲（Trypanosoma cruzi）

B. Winterbottom's sign－岡比亞錐蟲（Trypanosoma brucei gambiense）

C. Megaesophagus－杜氏利什曼原蟲（Leishmania donovani）

D. Espundia－巴西利什曼原蟲（Leishmania braziliensis）


Question: 在blood coagulation pathway的最後一步，促使fibrinogen轉化成fibrin的物質為何？

Answer: thrombin

A. von Willebrand factor

B. factor V

C. thrombin

D. plasminogen


Question: 39.58歲男性，近半年感到腹部不適，某日就診時發現有兩側頸部、腋下與腹股溝淋巴結腫大。病人體溫 38.8℃，血壓90/50mmHg，並有畏寒與疲累的症狀，血球檢查數據如下（括弧內是正常參考數值）：RBC  4.12 M/μL（4～5.52），Hb 12.4 g/dL（13.2～17.2），Retic. 1.48%（0.5～2），PLT 261 k/μL（148～339）， WBC 9.74 k/μL（3.54～9.06），Blast 0% ，Promyel. 0%，Myelo. 0%，Meta 0%，Band 0%，Seg 5.0%，Eos.  3.0%，Baso. 1.0%，Mono. 8.0%，Lym. 83.0%，Aty.Lym. 0.0%，Plasma cell 0.0%，Normobl. 0.0/100 WBC。以 下那個敘述錯誤？

Answer: 因為白血球總數正常，只需要症狀治療

A. 因為白血球總數正常，只需要症狀治療

B. 應該要做詳細的身體檢查，以找出可能的感染來源

C. 應該要接受血液細菌培養

D. 應該要儘早投與靜脈注射的廣效性抗生素


Question: 一位 24 歲男性病人主訴下背疼痛已半年。症狀時好時壞。嚴重時，可能半夜或清晨會痛醒。該病人最不可能同時有下列那一種症狀或徵兆？

Answer: 皮下結節（subcutaneous nodule）

A. 虹彩炎（iritis）

B. 香腸趾（sausage toe）

C. 皮下結節（subcutaneous nodule）

D. 足底筋膜炎（plantar fasciitis）


Question: 依據赫爾辛基宣言（Declaration of Helsinki），當使用可辨識之人體組織或資料進行研究時，須遵守的規定。下列何者錯誤？

Answer: 在不可能或無法取得同意之情況，或取得同意後將造成研究無效時，可在免除同意書之情況下進行

A. 通常醫師必須取得同意後，方可收集、分析、儲存和再利用

B. 在不可能或無法取得同意之情況，或取得同意後將造成研究無效時，可在免除同意書之情況下進行

C. 在不可能或無法取得同意之情況，或取得同意後將造成研究無效時，此種研究需經研究倫理委員會審議和批准後，方可在免除同意書之情況下進行

D. 醫師應避免受試者在壓力或脅迫下取得同意


Question: 根據世界衛生組織宣佈，下列何種疾病因為病毒疫苗之使用而絕跡？

Answer: 天花（smallpox）

A. 天花（smallpox）

B. 流行性感冒

C. 小兒麻痺

D. 水痘


Question: 醫師法所稱之醫師不包括下列那一項？

Answer: 獸醫師

A. 中醫師

B. 獸醫師

C. 醫師

D. 牙醫師


Question: 下列那一種組織結構不被外淋巴液（perilymph）所包圍？

Answer: 鎚骨（malleus）

A. 橢圓囊（utricle）

B. 耳蝸管（cochlea duct）

C. 鎚骨（malleus）

D. 球囊（saccule）


Question: 下列何者是亞急性皮膚紅斑性狼瘡 （subacute cutaneous lupus erythematosus；SCLE）常見的皮膚表現形式？

Answer: papulosquamous 與 annular lesions

A. malar rash 與 papulosquamous lesions

B. papulosquamous 與 annular lesions

C. malar rash 與 discoid rash

D. discoid rash 與 annular lesions


Question: 一位 84 歲男性病患，過去曾在金礦坑內工作長達 30 年，6 個星期前因為咳嗽加劇、黃痰，及下午發燒送醫，痰液抹片檢查發現 AFB（Acid-fast bacilli）(+++)，醫生當時開立第一線治療之標準四種抗結核藥物。如今結核菌培養呈現 MDR（multidrug resistant）TB，檢驗結果顯示對下列那些藥物產生抗藥性？

Answer: Rifampin+Isoniazid

A. Rifampin+Isoniazid

B. Rifampin+Isoniazid+Ethambutol

C. Isoniazid+Ethambutol

D. Isoniazid+Pyrazinamide


Question: 感染下列何種病毒，若自行服用阿司匹靈（Aspirin）等水楊酸類（salicylates）退燒藥物後，最易增加兒童罹患雷氏症候群（Reye syndrome）的風險？

Answer: 流感病毒（Influenza virus）

A. 德國麻疹病毒（Rubella virus）

B. 麻疹病毒（Measles virus）

C. 流感病毒（Influenza virus）

D. 狂犬病病毒（Rabies virus）


Question: 有關治療產後大量出血之血管內栓塞術的敘述，下列何者最正確？

Answer: 栓塞的目標是止血並盡量保存子宮

A. 血管內栓塞術是唯一的治療方法

B. 栓塞的目標是止血並盡量保存子宮

C. 栓塞兩側子宮靜脈對止血的效果最好

D. 栓塞兩側子宮動脈的後遺症是會造成卵巢壞死


Question: 高血壓的預防和控制指引，不包括下列何者？

Answer: 增加鈉鹽攝取

A. 體重控制

B. 增加鈉鹽攝取

C. 增加體能活動

D. 飲酒適量


Question: 關於重積癲癇（status epilepticus）治療，下列何者錯誤？

Answer: 癲癇發作時應立即給與抗癲癇藥物如phenytoin，並避免給予苯二氮類藥物（benzodiazepines）如

A. 癲癇發作時應立即給與抗癲癇藥物如phenytoin，並避免給予苯二氮類藥物（benzodiazepines）如

B. 抗癲癇藥物應使用靜脈注射類而不是口服類

C. 若使用抗癲癇藥物後仍持續發作，進入頑固性重積癲癇（refractory status epilepticus），應再加上麻醉類藥物如propofol

D. 腦波監控是必要檢查


Question: 下列何者與味蕾感覺訊號的傳遞，較不相關？

Answer: trigeminal nerve

A. trigeminal nerve

B. facial nerve

C. glossopharyngeal nerve

D. vagus nerve


Question: 有關骨骼肌和平滑肌的比較，下列敘述何者錯誤？

Answer: 骨骼肌可經有絲分裂增殖，平滑肌則否

A. 骨骼肌是多核細胞，平滑肌是單核細胞

B. 骨骼肌細胞核位在細胞的周邊，平滑肌細胞核位在中央

C. 骨骼肌具有橫紋，平滑肌則無

D. 骨骼肌可經有絲分裂增殖，平滑肌則否


Question: 下列何者為管理學 SWOT 分析中與外部環境相關之面向？

Answer: 機會（opportunity）和威脅（threat）

A. 機會（opportunity）和威脅（threat）

B. 優勢（strength）和劣勢（weakness）

C. 機會（opportunity）和劣勢（weakness）

D. 優勢（strength）和威脅（threat）


Question: 下列有關白喉毒素（diphtheria toxin）的敘述，那一項錯誤？

Answer: 是一種endotoxin

A. 是一種endotoxin

B. 可結合至細胞表面之heparin-binding epidermal growth factor

C. 可結合至心臟及神經細胞導致受損

D. A subunit會使細胞內的elongation factor 2（EF-2）失去活性


Question: 一位 6 個月大的嬰兒患有神經母細胞瘤，原腫瘤已完全切除，但腫瘤已轉移到肝臟，則該疾病算是那一期？

Answer: 4S

A. 2B

B. 3

C. 4

D. 4S


Question: 一位 25 歲喜好運動之男性，於三年前因車禍造成膝後十字韌帶斷裂，雖經積極復健，但走路膝關節內側疼痛，理學檢查呈現向後不穩定大於 10 毫米，他應接受何種治療？

Answer: 手術重建（reconstruction）

A. 繼續復健（rehabilitation）

B. 石膏固定（casting）

C. 手術修補（direct repair）

D. 手術重建（reconstruction）


Question: 臨床上成功應用於breast cancer免疫療法的單株抗體trastuzumab（Herceptin）是針對下列那一個分子？

Answer: Her-2/neu

A. Her-2/neu

B. MAG-1

C. MUC-1

D. CD-20


Question: 足月產之嬰兒，第一天血紅素（Hb）濃度為 12 g/dL，平均紅血球體積（MCV）為 110 fL，則下列判讀何者為真？

Answer: 正紅血球性貧血（normocytic anemia）

A. 完全正常

B. 小紅血球性貧血（microcytic anemia）

C. 正紅血球性貧血（normocytic anemia）

D. 大紅血球性貧血（macrocytic anemia）


Question: 下列何者最有可能引起血壓下降？

Answer: 增加小動脈一氧化氮（NO）的量

A. 活化小動脈血管平滑肌β1 腎上腺素型受器（β1 adrenergic receptors）

B. 開啟小動脈血管平滑肌細胞上鈣離子通道（calcium channel）

C. 增加小動脈一氧化氮（NO）的量

D. 活化血管張力素轉換酶（angiotensin-converting enzyme）


Question: 在成年男性，下列何種病毒性疾病最易侵犯睪丸？

Answer: 腮腺炎（mumps）

A. 麻疹（measles）

B. 德國麻疹（rubella）

C. 腮腺炎（mumps）

D. 疱疹（herpes）


Question: 有關Toxic shock syndrome的敘述，下列何者錯誤？

Answer: 主要致病機轉為Pseudomonas 製造的exfoliative toxin所引起

A. 臨床上表現包括⼤⾯積⽪膚紅腫疼痛或是膿皰、以及⽪膚廣泛性脫屑現象

B. 初期會出現⽪膚疼痛現象，⼤部分是因為術後傷⼝感染或是腹腔感染引起

C. 病患會出現發燒、喉嚨痛、肌⾁痠痛、嘔吐或是腹瀉，嚴重時會造成低⾎壓以及多重器官衰竭

D. 主要致病機轉為Pseudomonas 製造的exfoliative toxin所引起


Question: 在靜脈注射一個大劑量的短效胰島素製劑造成低血糖時，下列何種狀況最不會造成血糖回升延遲的現象？

Answer: 副甲狀腺素分泌不足

A. 腎上腺髓質發育不全

B. 升血糖素（glucagon）分泌缺乏

C. 甲狀腺功能低下

D. 副甲狀腺素分泌不足


Question: 30 歲男性，數年來有反覆發作之全身銀灰色鱗屑性紅色斑塊，3 個月前這些病灶集中在指（趾）尖及指（趾）甲周圍，且合併脊椎及手指末端關節炎，又 HLA-B27(+)。下列何者為首選口服治療藥物？

Answer: methotrexate

A. retinoids

B. methotrexate

C. cyclosporine

D. glucocorticoids


Question: 35.婦科手術後，若有	血症（septicemia）引起alveolar-capillary membrane的微血管側受損，使肺部微血管通透 性增加，而造成肺部的併發症，稱為：

Answer: Acute respiratory distress syndrome

A. Pulmonary edema

B. Pulmonary hypertension

C. Respiratory permeability defect

D. Acute respiratory distress syndrome


Question: 下列何種周邊視網膜變性與視網膜剝離關係最密切？

Answer: 格子狀變性（lattice degeneration）

A. 囊狀視網膜變性（cystoid degeneration）

B. 格子狀變性（lattice degeneration）

C. 萎縮性視網膜裂孔（atrophic retinal hole）

D. 卵石狀視網膜變性（paving stone degeneration）


Question: 下列何種疾病不可使用 GnRH（gonadotropin-releasing hormone）agonist 治療？

Answer: 肢端肥大症（acromegaly）

A. 無月經（amenorrhea）

B. 前列腺癌症（prostate cancer）

C. 乳癌（breast cancer）

D. 肢端肥大症（acromegaly）


Question: 使用下列那一種麻醉劑時，最需要再合併給予肌肉鬆弛劑？

Answer: Nitrous oxide

A. Halothane

B. Benzodiazepines

C. Isoflurane

D. Nitrous oxide


Question: 7 歲小男生因下肢及臀部出現紅色點狀物（如附圖），其血小板數目正常，同時有膝蓋關節痛與陣發性腹痛之情形，尿液檢查發現其同時有血尿的情形，請問最有可能之診斷為何？

Answer: Henoch-Schönlein purpura

A. Henoch-Schönlein purpura

B. Ig A nephropathy

C. scarlet fever

D. juvenile rheumatoid arthritis


Question: ⿐咽癌的⾎液測試中，下列何者⽬前被認為準確度最好？

Answer: Serum/Plasma free EBV DNA copies

A. EBV anti-VCA IgG

B. EBV anti-VCA IgA

C. EBV anti-EA IgA

D. Serum/Plasma free EBV DNA copies


Question: 有關頭部神經或血管路徑的敘述，下列何者正確？

Answer: 顏面神經（facial nerve）穿過莖乳孔（stylomastoid foramen）

A. 眼動脈（ophthalmic artery）穿過眶上裂（superior orbital fissure）

B. 顏面神經（facial nerve）穿過莖乳孔（stylomastoid foramen）

C. 三叉神經上頜支（maxillary division of trigeminal nerve）穿過卵圓孔（foramen ovale）

D. 前庭耳蝸神經（vestibulocochlear nerve）穿過頸靜脈孔（jugular foramen）


Question: 關於Noonan syndrome之敘述，下列何者錯誤？

Answer: 主動脈狹窄（aortic stenosis）為其最常見的心臟病變

A. 身材矮小

B. 蹼狀頸（webbed neck）

C. 正常染色體核型（normal karyotype）

D. 主動脈狹窄（aortic stenosis）為其最常見的心臟病變


Question: 一位 63 歲長期抽菸的男性喉癌病人（鱗狀上皮細胞）；手術一年後發現肺部廣泛轉移。於 cisplatin/5-FU 化學治療結束後第二天出院。但隔天其太太發現病人意識不清，於是送病人至急診。呼吸及血壓均正常，但心跳 112/分。何者是最適當之處置？

Answer: 檢驗血中 calcium

A. 血液細菌培養，使用選擇性抗綠膿桿菌之抗生素

B. 檢驗血中 calcium

C. 檢驗血液中NH3

D. 腦部核磁共振


Question: 下列有關 E. coli 修補 O6-methylguanine 的敘述，何者正確？

Answer: 利用甲基轉移酶將甲基送到甲基轉移酶本體

A. 利用甲基轉移酶（methyltransferase）將甲基送到四氫葉酸（tetrahydrofolate）

B. 利用甲基轉移酶將甲基送到甲基轉移酶本體

C. 利用 DNA 去甲基酶（DNA demethylase）送到四氫葉酸

D. 利用 DNA 去甲基酶送到水中


Question: 一中年女性主訴手指會麻，下列那一部位的感覺缺失可使醫師確認受傷的神經是尺神經（ulnar nerve）？

Answer: 小指的掌面（palmar surface of the 5th finger）

A. 大拇指的掌面（palmar surface of thumb）

B. 前臂掌面的尺側（ulnar side of the volar surface of forearm）

C. 小指的掌面（palmar surface of the 5th finger）

D. 手背近虎口處（dorsum of hand between the thumb and the 2nd finger）


Question: 一名40多歲男性右眼紅痛，經診斷為急性前部葡萄膜炎（acute anterior uveitis），並伴有多年下背痛病史，則下列何者錯誤？

Answer: 常雙眼同時發作

A. 好發於男性

B. X光可能發現竹狀脊椎（bamboo spine）

C. 常雙眼同時發作

D. 與HLA-B27相關


Question: 21 歲大學生準備前往某開發中國家旅遊，該地是 A 型肝炎疫區，他沒有免疫力，希望不要得到感染，下列敘述何者錯誤？

Answer: A 型肝炎疫苗與免疫球蛋白不能同時施打

A. 應接種 A 型肝炎疫苗或施打免疫球蛋白（immune serum globulin, ISG）

B. A 型肝炎疫苗與免疫球蛋白不能同時施打

C. 如果 2 週內即將前往，應施打免疫球蛋白（ISG）較具保護力

D. 如果計劃多次到開發中國家旅遊，施打 A 型肝炎疫苗較合成本效益


Question: 78.曼森裂頭絛蟲（Spirometra mansonoides）那些發育時期的蟲體可以感染人？①六鈎幼蟲卵

Answer: ③④

A. ①②

B. ①③

C. ②④

D. ③④


Question: 下列何者會因胃擴張（Distension）之刺激而分泌？

Answer: 胃泌素（Gastrin）

A. 膽囊收縮素（Cholecystokinin）

B. 胃抑素（Gastric inhibitory peptide）

C. 胃泌素（Gastrin）

D. 體抑素（Somatostatin）


Question: 承上題，依Parkland formula，下列敘述何者正確？

Answer: 輸液前8小時給crystalloid溶液2160 mL

A. 輸液前8小時給crystalloid溶液4320 mL

B. 輸液前12小時給crystalloid溶液4320 mL

C. 輸液前8小時給crystalloid溶液2160 mL

D. 輸液前12小時給crystalloid溶液2160 mL


Question: 腋神經（axillary nerve）受損時，會造成下列那一塊旋轉	（rotator cuff）肌肉無力？

Answer: 小圓肌（teres minor）

A. 棘上肌（supraspinatus muscle）

B. 棘下肌（infraspinatus muscle）

C. 肩胛下肌（subscapularis muscle）

D. 小圓肌（teres minor）


Question: 與大部分血管新生（angiogenesis）關係最密切的生長因子（growth factor）為何？

Answer: VEGF（vascular endothelial growth factor）

A. PDGF（platelet-derived growth factor）

B. IGF-1（insulin-like growth factor-1）

C. VEGF（vascular endothelial growth factor）

D. TGF-β（transforming growth factor-β）


Question: 下列何者與先天性白內障無關？

Answer: 丁氣體；12

A. 甲氣體；2.4

B. 乙氣體；0.42

C. 丙氣體；1.9

D. 丁氣體；12


Question: 一名 6 歲女孩因為手臂骨折而住院，身體診查發現乳房已有發育，皮膚呈現咖啡牛奶斑（café-au-lait spots），甲狀腺機能亦有亢進現象，影像檢查顯示骨骼纖維性發育不良（fibrous dysplasia），骨齡判讀為 9 歲，最可能的診斷是：

Answer: McCune-Albright syndrome

A. Fanconi syndrome

B. McCune-Albright syndrome

C. neurofibromatosis

D. Peutz-Jeghers syndrome


Question: 下列何者不是Bishop score的評分項目之一？

Answer: 生產次數（parity）

A. 生產次數（parity）

B. 子宮頸擴張程度（dilatation）

C. 子宮頸軟化程度（effacement）

D. 胎頭於骨盆的位置（station）


Question: 下列有關骨髓（bone marrow）的敘述，何者正確？

Answer: 具有竇狀系統（sinusoidal system），是一個封閉型的循環系統，新生的血球細胞必須穿透內皮（endothelium），才能進入循環

A. 具有竇狀系統（sinusoidal system），是一個封閉型的循環系統，新生的血球細胞必須穿透內皮（endothelium），才能進入循環

B. 黃骨髓（yellow bone marrow）是活化的骨髓，負責製造各種血球細胞

C. 在長骨（long bone）內的非造血空間，會被纖維母細胞（fibroblast）占據

D. 巨核細胞（megakaryocyte）釋放的血小板（platelet），必須藉由網狀細胞（reticular cell）的協助，才能進入竇狀系統（sinusoidal system）


Question: 一位 50 歲女性，發現右側甲狀腺腫大 1 個月，於門診理學檢查及超音波檢查發現右側甲狀腺有 1 個 3 公分腫瘤，無頸淋巴腫大，細針抽吸細胞學檢查為乳突性甲狀腺癌，該病人接受甲狀腺全切除，手術後發生呼吸困難。關於病人發生呼吸困難之問題，下列敘述何者錯誤？

Answer: 手術後 2 小時發生呼吸困難，可能為副甲狀腺受損，導致低血鈣進而全身麻木，呼吸不適

A. 手術後一拔管立刻發生呼吸困難，可能為雙側喉返神經受損造成聲帶麻痺，導致呼吸道阻塞

B. 手術後當天晚上發生呼吸困難，可能為頸部血腫壓迫氣管，造成氣管軟化及呼吸道阻塞

C. 手術後 2 小時發生呼吸困難，可能為副甲狀腺受損，導致低血鈣進而全身麻木，呼吸不適

D. 可能因為傷口疼痛精神緊張造成過度換氣症候


Question: 當疑有 submandibular duct 的結石時，下列何者為最恰當的影像診斷方式？

Answer: dental occlusal view

A. skull basal view

B. dental occlusal view

C. skull lateral view

D. Caldwell view


Question: 下列那種細菌以家禽、家畜為其貯存宿主（reservoir）？

Answer: 空腸彎曲菌（Campylobacter jejuni）

A. 空腸彎曲菌（Campylobacter jejuni）

B. 霍亂弧菌（Vibrio cholerae）

C. 百日咳桿菌（Bordetella pertussis）

D. 腦膜炎奈瑟氏菌（Neisseria meningitidis）


Question: 有關low-molecular-weight heparin（LMWH）特點的敘述，何者錯誤？

Answer: 一般可以用凝血時間的檢	做監測，維持約正常值的兩倍左右

A. LMWH的使用劑量一般可依體重決定就好

B. 一般可以用凝血時間的檢	做監測，維持約正常值的兩倍左右

C. 必要時可以監測Factor Xa activity看LMWH的藥量是否恰當

D. LMWH主要由腎臟代謝排出


Question: 一個 2 歲 8 個月大的女孩，來診發現肝脾極度腫大，分別在肋骨下 3 公分及 8 公分摸到，其血色素（Hb）為 6.5 g/dL，血小板（platelets）數目低為 88,000/mm3，檢查無缺鐵，血色素電泳分析（hemoglobin electrophoresis）Hb A 為 93.0%，Hb A2 為 5.1%，Hb F 為 1.9%，骨髓檢查無惡性細胞浸潤，但有貯積細胞，周邊血白血球測定之β-glucosidase 酵素活性甚低，下列何者為最可能診斷？

Answer: 高雪氏病（Gaucher disease）

A. 重型乙型海洋性貧血（β-thalassemia）

B. 重型甲型海洋性貧血（α-thalassemia）

C. 重度再生不良性貧血（Severe aplastic anemia）

D. 高雪氏病（Gaucher disease）


Question: 有關肝細胞癌（hepatocellular carcinoma，即HCC）的臨床評估及診治，以下敘述何者錯誤？

Answer: 正子攝影（FDG-PET）已被證實是診斷HCC最敏感的影像檢查方式

A. 理學檢查時，應注意是否有jaundice、ascites、spider angioma、palmar erythema等可能指出有chronic liver disease或liver cirrhosis的signs

B. 血清AFP是常用的tumor marker；但並非所有的HCC患者，血清AFP皆會升高

C. ultrasound，triphasic CT及gadolinium-enhanced MRI皆是可應用來協助診斷HCC的影像檢查方式

D. 正子攝影（FDG-PET）已被證實是診斷HCC最敏感的影像檢查方式


Question: 承上題，下列那項是該嬰兒最可能之 blood gas 檢查結果？

Answer: metabolic alkalosis and respiratory acidosis

A. metabolic alkalosis and respiratory acidosis

B. metabolic acidosis and respiratory alkalosis

C. metabolic acidosis and respiratory acidosis

D. metabolic alkalosis and respiratory alkalosis


Question: 21 急診常有受傷需縫合的傷口，關於拆線時間，下列敘述何者正確？①頭皮 6～8 天 ②眼皮 10～14 天  ③背部 12～14 天 ④四肢 12～14 天

Answer: ①③④

A. ①②④

B. ①②③

C. ②③④

D. ①③④


Question: 29 歲女性經門診醫師診斷甲狀腺單邊有一結節，有關診斷之敘述，下列何者錯誤？

Answer: 做 CT 及 MRI 檢查

A. 應有發生時間及症狀、家族史的資料

B. 做超音波及 FNA（小針切片細胞學檢查）

C. 做 TSH 檢查

D. 做 CT 及 MRI 檢查


Question: 心臟超音波檢查是下列何種疾病的最佳診斷利器？

Answer: 心包囊積水

A. 急性心肌梗塞

B. 心包囊積水

C. 心房中隔缺損

D. 心室中隔缺損


Question: 54 歲女性失足從 3 公尺高度跌下，嚴重呼吸困難及右胸壁血腫。被送到急診身體檢查，意識昏昏欲睡，血壓測不到，發紺、心動過速與右側呼吸聲減少。你是值班醫生，你的及時處理為何？

Answer: 插胸管

A. 胸部 X 光及電腦斷層掃描

B. 插 CVC 用全速靜脈輸液

C. 插胸管

D. 給予 inotropics


Question: 95 國民健康局想進行世代研究（cohort study），探討運動是否可減少發生冠心症的危險。這個世代必 須是建立在：

Answer: 沒有罹患冠心症的人

A. 已經罹患了冠心症的人

B. 沒有罹患冠心症的人

C. 已經有運動習慣的人

D. 沒有運動習慣的人


Question: 下列有關肺臟移植的敘述，何者錯誤？

Answer: 肺功能檢查若是有 FVC 數據顯著下滑的情形，可作為診斷排斥作用發生之 criteria

A. 常見之 surgical indicatoins 為 COPD、pulmonary fibrosis 及 pneumoconiosis 等疾病所造成之肺部永久性傷害

B. prednisolone、cyclosporine 與 azathioprine 為常併用之免疫抑制藥物

C. 急性排斥發生時，病患常出現 dyspnea、leukocytosis 及 mild fever 等症狀

D. 肺功能檢查若是有 FVC 數據顯著下滑的情形，可作為診斷排斥作用發生之 criteria


Question: 你的門診診間進來一位初診病人，23 歲的阿凱是研究所一年級的學生。他的主訴為昨晚開始發燒、咳嗽、流鼻水，你問診及做完身體檢查，診斷他的問題為上呼吸道感染。正要開藥時，他要求你為他開一張診斷證明書，因為學校後天要期末考，他擔心感冒影響考試的準備，希望你在診斷證明書上註明他需要在家休息 3 天。下列何種作法最為恰當？

Answer: 經說明後，僅開給他當天之就醫證明

A. 打電話給他的父或母親

B. 問他是否得到老師的許可

C. 經說明後，僅開給他當天之就醫證明

D. 轉介給另一位門診醫師處理


Question: 下列何者不屬於美國精神醫學會「精神疾患診斷及統計手冊第四版」之焦慮性疾患（anxiety disorders）？

Answer: 適應障礙合併焦慮

A. 創傷後壓力疾患

B. 恐慌症

C. 適應障礙合併焦慮

D. 社交畏懼症


Question: 有關病人在不同壓力下所需的營養需求敘述，下列何者錯誤？

Answer: 燒傷病人每天所需的蛋白質攝取量為 2.0 g/kg/day

A. mild stress 下，病人所需的熱量為 25～30 kcal/kg/day

B. 燒傷病人每天所需的蛋白質攝取量為 2.0 g/kg/day

C. 燒傷病人每天的熱量攝取為 35～40 kcal/kg

D. moderate malnutrition 的病人，非蛋白質的熱量攝取與氮素比為 150：1


Question: 承上題，關於乳癌的改良式根治性乳房切除手術（modified radical mastectomy）治療，下列何者錯誤？

Answer: 前哨淋巴結切片（sentinel lymph node biopsy）無法避免腋下淋巴結清除手術的合併症，通常用於縮短手術時間

A. 改良式根治性乳房切除包含清除腋下的淋巴結，通常清除level 1 與 level 2的範圍

B. 腋下淋巴結清除的解剖位置，上界為腋靜脈（axillary vein），內界為胸壁，外界為背闊肌

C. 腋下淋巴清除手術的合併症包括疼痛、減少關節活動範圍、淋巴水腫等

D. 前哨淋巴結切片（sentinel lymph node biopsy）無法避免腋下淋巴結清除手術的合併症，通常用於縮短手術時間


Question: 一糖尿病中年婦女，突然頭部劇痛、左眼瞼下垂、複視、瞳孔放大，來急診求治，神智清楚，腦部電腦斷層如附圖，下列處置何者最恰當？

Answer: 住院，馬上安排腦部血管攝影

A. 住院，馬上安排腦部血管攝影

B. 抽血密切注意血糖的變化

C. 住院，檢	是否有重症肌無力（myasthenia gravis）

D. 安排腦部核磁共振，再決定是否要住院


Question: 張太太的女兒現年 10 歲，自上學期中就開始經常口渴，有消瘦現象。有一天昏倒送醫之後，診斷得到第一型糖尿病，胰臟之β（beta）細胞破壞嚴重，缺乏胰島素，血糖過高。這個疾病的成因為何？

Answer: 產生自體免疫反應 T 細胞，破壞胰臟β（beta）細胞所致的自體免疫疾病

A. 感染症破壞胰臟腺體，引起胰臟功能過高

B. 攝取糖份過多，引起胰臟功能衰竭

C. 產生自體免疫反應 T 細胞，破壞胰臟β（beta）細胞所致的自體免疫疾病

D. 電解質代謝失常，引起胰臟功能衰竭


Question: 蛋白質最常經下列何種轉譯後修飾（post-translational modification），再送到溶酶體（lysosome）？

Answer: 糖基化（glycosylation）

A. 糖基化（glycosylation）

B. 磷酸化 （phosphorylation）

C. 蘇素化（sumoylation）

D. 乙醯化（acetylation）


Question: 一位 28 歲 AIDS 患者，主訴為大腿內側突然出現數顆 2-4 mm 的丘疹，其中心具有 umbilication 的現象。其皮膚切片如圖示，最可能的診斷是：

Answer: 傳染性軟疣（molluscum contagiosum）

A. 尋常疣（verruca vulgaris）

B. 扁平疣（verruca plana）

C. 傳染性軟疣（molluscum contagiosum）

D. 尖端濕疣（condyloma acuminata）


Question: 1 一位五十歲病患術後小便減少，其小便的鈉離子低於 20 mOs/L，小便和血漿的 creatinine 比值大於 40 ，則小便減少的原因是何種的問題？

Answer: Prerenal

A. Prerenal

B. Renal

C. Postrenal

D. 不一定


Question: 承上題，檢查結果最可能合併的畸形為下列何者？

Answer: Neural tube defect

A. Down syndrome

B. Trisomy 13

C. Trisomy 18

D. Neural tube defect


Question: 患者長期服用抗癲癇藥物時，下列何種情況最不需要做血中藥物濃度監測？

Answer: 合併使用無交互作用之藥物

A. 懷疑病人服藥不確實

B. 癲癇發作呈現重積狀態

C. 病人本身有肝腎疾病

D. 合併使用無交互作用之藥物


Question: 75.⼀位46歲男性，胸部遭攻擊造成⾎胸合併休克，胸管引流出700 ml⾎液後，⾎壓為118/82 mmHg，⼼跳90 	下/分，幾分	後⾎壓下降為84/62 mmHg，⼼跳126下/分，下列處置何者最優先？

Answer: 重新評估病⼈

A. 立即氣管插管

B. 緊急開胸

C. 立即輸⾎

D. 重新評估病⼈


Question: 在光學顯微鏡下觀察下列何種型式的血管，其內彈性板（internal elastic lamina）最明顯且呈波浪狀？

Answer: 肌性動脈（muscular artery）

A. 彈性動脈（elastic artery）

B. 肌性動脈（muscular artery）

C. 微血管（capillary）

D. 小靜脈（venule）


Question: 一鼻咽癌病患抱怨雙側手臂與大腿疼痛，下列何者是最適當的檢查工具？

Answer: 同位素骨骼掃描

A. 超音波

B. 電腦斷層掃描

C. 核磁共振造影

D. 同位素骨骼掃描


Question: 一位 82 歲的骨癌末期併肺部移轉的病人在安寧病房中，並已簽署 DNR，主訴呼吸困難，下列何者是最不適宜的處置？

Answer: 安排胸部電腦斷層攝影檢查

A. 安排胸部電腦斷層攝影檢查

B. 給予 lorazepam

C. 給予氧氣治療

D. 給予 codeine


Question: 下列有關使用心臟節律器（pacemaker）的病人，進行麻醉前評估與準備之敘述，何者錯誤？

Answer: 置放磁鐵於麻醉中的病人之胸前pacemaker上，即可完全避免術中電燒的干擾與危害

A. 進行非心臟常規手術前，應重新檢查心臟節律器的功能

B. 置放磁鐵於麻醉中的病人之胸前pacemaker上，即可完全避免術中電燒的干擾與危害

C. 術中應關閉心電圖監視器上filter的功能，以免偵測不到節律放電波形（pacing spikes）

D. 術中除使用心電圖監視器外，應配合使用脈動式血氧飽和監測儀（pulse oximetry）


Question: 下列有關腦部偽腫瘤（pseudotumor cerebri）的敘述，何者錯誤？

Answer: 常伴隨腦室變大

A. 常伴隨腦室變大

B. 腦壓增高，作腰椎穿刺壓力往往超過200 mmH2O

C. 會有視乳突水腫（papilledema）

D. 內科治療以類固醇及利尿劑為主


Question: 下列關於功能性腸胃道疾患（functional gastrointestinal disorders）敘述，何者錯誤？

Answer: 在與功能性腸胃道疾患共病的焦慮疾患中，創傷後壓力症候群（posttraumatic stress disorder）是最常出現的

A. 具有腸胃道收縮異常以及功能性食道症狀的病人經常合併有精神疾病

B. 焦慮症為功能性腸胃道疾患常見的精神科共病

C. 在與功能性腸胃道疾患共病的焦慮疾患中，創傷後壓力症候群（posttraumatic stress disorder）是最常出現的

D. 恐慌發作的症狀亦包含了腸胃道症狀


Question: 病理診斷狂⽝病（Rabies）的最主要依據是觀察到：

Answer: Negri body

A. Lewy body

B. Kuru plaque

C. Negri body

D. Stress granules


Question: 20 歲孕婦，G1P0，妊娠 31 週，主訴：頭痛，視力模糊有一天之久。血壓 200/140 mmHg，下肢水腫（+++），蛋白尿（++++），深部肌腱反射（+++），GOT 上升，血小板下降，有溶血現象。請問最可能的診斷為何？

Answer: HELLP 症候群

A. 肝昏迷

B. 腎衰竭

C. 子癇症

D. HELLP 症候群


Question: 結膜的杯狀細胞（goblet cells），可以分泌淚液的那一種成分？

Answer: 黏液（mucin）

A. 脂肪（lipid）

B. 水（aqueous）

C. 黏液（mucin）

D. 電解質（electrolytes）


Question: 一位病人因為單純性闌尾炎（simple appendicitis）接受闌尾切除術，術中並無腸內容物外漏，屬於下列何種手術傷口分類？

Answer: clean-contaminated

A. clean

B. clean-contaminated

C. contaminated

D. dirty and infected


Question: 有關於hiatal hernia之描述，下列何者正確？

Answer: sliding hiatal hernia（type I）常伴隨胃酸逆流之症狀

A. sliding hiatal hernia（type I）常伴隨胃酸逆流之症狀

B. paraesophageal hiatal hernia指的是腹部的大腸、小腸等herniation to the chest

C. paraesophageal hiatal hernia與sliding hiatal hernia是不同的兩種情形，不會同時出現

D. 絕大部分的sliding hiatal hernia須接受手術治療


Question: 張小弟目前是小學六年級學生，大約 3 年前開始，他會不自主的皺眉頭、眼睛亂飄、扮鬼臉以及發出聲音等動作，因此常常被老師糾正。最近更加上時常口出穢語，自己無法控制。除此之外，身體理學以及神經學檢查正常，也沒有慢性疾病。下列臨床診斷何者最有可能？

Answer: 妥瑞氏症（Tourette's disorder）

A. 過動兒（hyperkinetic child）

B. 全肌張力不全症（generalized dystonia）

C. 妥瑞氏症（Tourette's disorder）

D. 亨丁頓氏舞蹈症（Huntington's chorea）


Question: 造成攝護腺手術中併發 TURP 症候群之可能原因，下列何者錯誤？

Answer: 失血過多

A. 循環體液過多

B. 水中毒

C. 沖洗液內溶物毒性

D. 失血過多


Question: 電腦斷層檢查發現廣泛頭骨增厚（diffuse skull thickening），下列何者最不會發生？

Answer: 水腦症（hydrocephalus）

A. 肢端肥大症（acromegaly）

B. 地中海型貧血（thalassemia）

C. 水腦症（hydrocephalus）

D. 小腦症（microcephaly）


Question: 免疫系統能夠偵查出腫瘤細胞的存在，並且盡力消滅它。免疫系統與腫瘤互動的階段依先後次序為何？

Answer: 消滅期→平衡期→逃避期

A. 逃避期（escape phase）→平衡期（equilibrium phase）→腫瘤之免疫調節期（immunoediting）

B. 逃避期→消滅期（elimination phase）→平衡期

C. 平衡期→逃避期→消滅期

D. 消滅期→平衡期→逃避期


Question: 與醫療資源耗用和配置較有關係的健康指標為何？

Answer: 疾病盛行率

A. 疾病盛行率

B. 疾病發生率

C. 有效接觸率

D. 平均餘命


Question: 當一個病人被診斷出有右側的輸尿管結石合併右腎積水，同時又有左側腎結石但無左腎積水；你覺得下列敘述中何者是最適當的治療步驟？

Answer: 先以體外震波碎石術或輸尿管鏡碎石術來治療右側的輸尿管結石，等結石廓清、腎積水消除後再處理左腎結石

A. 先將左腎結石用體外震波碎石術來治療，等結石廓清後再處理右側輸尿管結石

B. 同時為兩側的結石施行體外震波碎石術治療

C. 先以體外震波碎石術或輸尿管鏡碎石術來治療右側的輸尿管結石，等結石廓清、腎積水消除後再處理左腎結石

D. 先將右側輸尿管結石推回腎臟，再施予兩側的體外震波碎石術治療


Question: 一位 55 歲男性糖尿病病患發生水腫及蛋白尿超過每日 6 克，該病患合併增生性視網膜病變，下列何種處置不需立即執行？

Answer: 腎臟組織切片

A. 利尿劑

B. 腎臟組織切片

C. 限鹽飲食

D. 血管張力素接受體阻斷劑（angiotensin receptor blocker）


Question: Sulfonylureas類治療糖尿病藥物的主要作用機轉為何？

Answer: 促進胰島素的分泌

A. 抑制胰島素被肝臟代謝分解

B. 促進胰島素的生合成及敏感性

C. 增加細胞的胰島素受體數目

D. 促進胰島素的分泌


Question: 兒童嚴重型再生不良性貧血的治療選項中，下列何種治療方式之治癒率較高？

Answer: 血液幹細胞移植

A. 放射治療

B. 化療

C. 輸血

D. 血液幹細胞移植


Question: 下列那一種血漿蛋白不是以肝臟為主要的製造場所？

Answer: γ 球蛋白（γ-globulin）

A. 白蛋白（albumin）

B. β 球蛋白（β-globulin）

C. γ 球蛋白（γ-globulin）

D. 纖維蛋白原（fibrinogen）


Question: 一位腦中風（stroke）患者，其身體檢查發現有一側肢體的軀體感覺（somatosensory）功能缺損，而肌力（muscle power）正常。腦中風病灶最有可能位於：

Answer: 視丘（thalamus）

A. 大腦額葉（frontal lobe）

B. 大腦顳葉（temporal lobe）

C. 視丘（thalamus）

D. 大腦枕葉（occipital lobe）


Question: 有關急性呼吸窘迫症（acute respiratory distress syndrome；ARDS）病人的臨床處理原則的敘述，下列何者錯誤？

Answer: 在 ARDS 病人使用較高的呼吸末期正壓（positive end-expiratory pressure，PEEP）提升血氧的臨床策略，目前已經確認為最適當壓力與方法，可有效改善 ARDS 病人死亡率

A. 在 ARDS 病人使用較高的呼吸末期正壓（positive end-expiratory pressure，PEEP）提升血氧的臨床策略，目前已經確認為最適當壓力與方法，可有效改善 ARDS 病人死亡率

B. 趴姿（prone position）可以有效改善 ARDS 病人血氧，但沒有影響死亡率

C. 趴姿（prone position）目前建議應用在持續血氧過低 ARDS 病人

D. 使用吸入性一氧化氮（Inhaled NO）目前可以應用在持續血氧過低 ARDS 病人，但對於死亡率沒有影響 9 下列關於中心視網膜動脈阻塞（central retinal artery occlusion）之敘述，何者錯誤？


Question: 有關檢查脊髓受傷病患之敘述，下列何者錯誤?

Answer: 患者僅下肢麻痺，上肢肌力正常，可完全排除頸椎受傷

A. 患者若上、下肢完全麻痺，但腦神經系統正常，通常表示頸椎受傷

B. 患者僅下肢麻痺，上肢肌力正常，可完全排除頸椎受傷

C. 患者於外傷後 48～72 小時內還能保留肢體運動或感覺，通常表示有較佳之預後

D. 對任何脊椎受傷之患者，首要考量為不可任意移動頸部


Question: 使用下類那一種治療巴金森氏症藥物時，尿液及唾液經常會呈現褐色的狀況？

Answer: levodopa

A. selegiline

B. levodopa

C. amantadine

D. bromocriptine


Question: 一位 15 歲女童主訴過去幾個月有間歇性的發燒、手腕及踝關節痛。尿液檢查發現有血尿（hematuria）、蛋白尿（proteinuria）及膿尿（pyuria）。下列何種檢驗對診斷最有幫助？

Answer: 雙股 DNA（dsDNA）抗體

A. 雙股 DNA（dsDNA）抗體

B. 喉頭 A 群 beta 溶血性鏈球菌（group A beta-hemolytic streptococcus）培養

C. 小便培養

D. 紅血球沈澱速率（erythrocyte sedimentation rate）


Question: 第二頸髓完全損傷的患者，需要下列輔具，何者不包括在內？

Answer: 握柄加粗湯匙

A. 口控電動輪椅

B. 聲控電腦

C. 握柄加粗湯匙

D. 呼吸器


Question: 35歲男性，家住山上，在颱風之後清掃自家附近水溝，當時注意到有很多死老鼠，一週後因黃疸、茶色尿及發高燒被送到急診，最可能的致病菌是：

Answer: 鉤端螺旋體（Leptospira species）

A. 鉤端螺旋體（Leptospira species）

B. 腸病毒（enterovirus）

C. 流感病毒（influenza virus）

D. 登革熱病毒（dengue virus）


Question: 腎臟移植手術一個月之內比較少見的感染為何？

Answer: BK virus（polyoma）

A. BK virus（polyoma）

B. 泌尿道感染

C. oral candidiasis

D. herpesvirus


Question: 下列何種藥物可作為墮胎藥？

Answer: Dinoprostone

A. Alprostadil

B. Dinoprostone

C. Epoprostenol

D. Iloprost


Question: 承上題，在治療結束後，病人突然發生單側下肢腫脹，膚色略為暗紅，觸壓時沒有凹陷（non-pitting），無局部發熱現象，病人並無凝血功能異常也無栓塞的紀錄，則下列診斷及治療何者較正確？

Answer: Trousseau's syndrome，給予抗凝血劑及抗癌藥物

A. 下肢靜脈栓塞，給予抗凝血劑 heparin

B. 下肢水腫，給予利尿劑

C. Trousseau's syndrome，給予抗凝血劑及抗癌藥物

D. 下肢靜脈栓塞，給予血栓溶解劑 recombinant tissue plasminogen activator


Question: 下列那一種症狀不是由克沙奇 A 型病毒（Coxsackie A virus）所引起的？

Answer: 胸膜痛（pleurodynia）

A. 疹性咽峽炎（herpangina）

B. 心臟炎（carditis）

C. 胸膜痛（pleurodynia）

D. 腦膜炎（meningitis）


Question: 76.7歲男童因突發性高燒、吞嚥困難就醫，在對比劑注射後，接受電腦斷層掃描檢查如圖示，箭號所指病灶最可能診斷為何？

Answer: 咽喉後膿瘍

A. 扁桃腺炎

B. 咽喉後膿瘍

C. 咽喉癌

D. 甲狀腺水囊


Question: 下列何種疾病引起的低血鈉（hyponatremia）與血液稀釋無關？

Answer: 抗利尿激素不適當分泌症候群（syndrome of inappropriate antidiuretic hormone secretion）

A. 肝硬化（liver cirrhosis）

B. 鬱血性心臟衰竭（congestive heart failure）

C. 抗利尿激素不適當分泌症候群（syndrome of inappropriate antidiuretic hormone secretion）

D. 腎病症候群（nephrotic syndrome）


Question: 承上題，上述診斷之最佳手術治療方法為：

Answer: 下視丘刺激術（subthalamic stimulation）

A. 蒼白球切開術（pallidotomy）或燒灼術

B. 視丘刺激術（thalamic stimulation）

C. 下視丘刺激術（subthalamic stimulation）

D. 大腦皮質刺激術（cortical stimulation）


Question: 下列有關Clostridium difficile及其導致之腹瀉疾病之敘述，何者錯誤？

Answer: 治療後的復發率（recurrence rate）常低於5%

A. 健康新生兒無症狀腸道帶菌（asymptomatic fecal carriage）並不罕見

B. 通常為醫療照護相關之感染

C. 抗微生物製劑的使用是誘發本疾病的主因

D. 治療後的復發率（recurrence rate）常低於5%


Question: 利用視網膜雷射（laser photocoagulation）治療糖尿病視網膜病變的功效，不包括下列何者？

Answer: 可防止微血管瘤（microaneurysms）之發生

A. 可防止微血管瘤（microaneurysms）之發生

B. 可促使視網膜新生血管（neovascularization）之消退

C. 可減緩牽引型視網膜剝離（tractional retinal detachment）之惡化

D. 可減少玻璃體出血（vitreous hemorrhage）之機會


Question: 21歲男性因上頸部硬塊求診，接受對比劑注射後的電腦斷層掃描如圖⽰，則最可能診斷為何？

Answer: ⿐咽癌

A. ⿐咽癌

B. 淋巴管瘤

C. 上呼吸道感染

D. 深頸部感染症


Question: 下列何種神經肌肉阻斷劑的作用是直接抑制骨骼肌細胞內鈣離子自肌漿網釋出而使骨骼肌鬆弛？

Answer: Dantrolene

A. Baclofen

B. Dantrolene

C. Pancuronium

D. Atracurium


Question: 下列何種疾病是性聯遺傳（sex-linked recessive）？

Answer: 裘馨氏肌肉失養症（Duchenne muscular dystrophy）

A. 肢帶型肌肉失養症（limb-girdle muscular dystrophy）

B. 肌強直症（myotonic dystrophy）

C. 裘馨氏肌肉失養症（Duchenne muscular dystrophy）

D. 低鉀週期性麻痺（hypokalemic periodic paralysis）


Question: 下列何者不是 Framingham Heart Study 用來估算心血管疾病十年風險的指標？

Answer: 舒張壓

A. 總膽固醇

B. 高密度脂蛋白膽固醇值（HDL）

C. 舒張壓

D. 抽菸習慣


Question: 下列何種降血壓藥物的作用機轉是經由 NO-cGMP pathway？

Answer: Nitroprusside

A. Verapamil

B. Trimethaphan

C. Diazoxide

D. Nitroprusside


Question: 下列那一硬腦膜靜脈竇（dural venous sinuses）的血液直接注入內頸靜脈（internal jugular vein）？

Answer: 乙狀竇（sigmoid sinus）

A. 乙狀竇（sigmoid sinus）

B. 上岩竇（superior petrosal sinus）

C. 橫竇（transverse sinus）

D. 枕竇（occipital sinus）


Question: 關於眼瞼惡性腫瘤的敘述，下列何者錯誤？

Answer: ⽪脂腺癌⼀般好發在下眼瞼

A. 基底細胞癌（basal cell carcinoma）發⽣率最⾼

B. 鱗狀細胞癌（squamous cell carcinoma）⼀般預後較基底細胞癌差

C. ⽪脂腺癌（sebaceous gland carcinoma）臨床上易被誤診為慢性眼瞼炎或霰粒腫（chalazion）

D. ⽪脂腺癌⼀般好發在下眼瞼


Question: 下列有關出血性腦中風之敘述，何者錯誤？

Answer: 高血壓所導致之出血性腦中風最常發生於頂葉之大腦皮質

A. 不正常之腦內血管可以造成出血性腦中風

B. 不正常之血液凝集功能可以造成出血性腦中風

C. 出血性腦中風亦可發生於年輕人

D. 高血壓所導致之出血性腦中風最常發生於頂葉之大腦皮質


Question: 45.某勞工於甲、乙、丙場所分別工作2.5、3、2.5小時，若其甲苯濃度分別為40、150、20 ppm，其時量平均濃度 （TWA）為何？

Answer: 75 ppm

A. 70 ppm

B. 74 ppm

C. 75 ppm

D. 80 ppm


Question: 一位 21 歲男性患者，因胸痛及呼吸困難前來就診，胸部 X 光片如圖所示，下列何種處置最為適當？

Answer: 插胸管引流

A. 即時給予抗生素治療

B. 給予支氣管擴張劑吸入治療

C. 插胸管引流

D. 給予氧氣治療，並觀察病情


Question: 有關決定能力，下列敘述何者錯誤？

Answer: 根據「安寧緩和醫療條例」，末期病人意識昏迷或無法清楚表達意願時，由醫護人員根據病患最大利益進行代理

A. 一個人可能有能力決定住處的選擇，卻沒有能力決定接受何種治療

B. 根據「安寧緩和醫療條例」，末期病人意識昏迷或無法清楚表達意願時，由醫護人員根據病患最大利益進行代理

C. 「病患自主」和「尊重人格」的倫理原則要求讓有決定能力的人對醫療行使知情同意

D. 一個人可能因為精神錯亂而暫時失去決定能力，但之後又恢復這能力


Question: 法洛氏四合症（Tetralogy of Fallot）完全矯正後，長期追蹤若有嚴重的肺動脈瓣逆流，右心室擴大，及右心室功能失效，此時最好的處理方式為何？

Answer: 肺動脈瓣置換

A. 心房中隔造口（creation of atrial septal defect）

B. 肺動脈瓣置換

C. 三尖瓣置換

D. 使用降肺高壓藥物


Question: 下列何者不是愛滋病毒（human immunodeficiency virus）傳播的方式？

Answer: 共用餐具

A. 性行為未全程使用保險套

B. 共用針頭施打毒品

C. 共用餐具

D. 被愛滋病毒感染的母親哺餵母乳


Question: 16.3歲男童，因為咽喉疼痛伴隨吞嚥與呼吸困難送至急診室，經醫師檢查，發現他在每次吸氣時都出現明顯阻塞 的聲音，側頸X光（lateral neck x-ray）報告顯示會厭軟骨腫脹（swollen epiglottis），此最有可能是下列何種細菌感染所造成？

Answer: b型流感嗜血桿菌（Haemophilus influenzae type b）

A. b型流感嗜血桿菌（Haemophilus influenzae type b）

B. 無乳鏈球菌（Streptococcus agalactiae）

C. 奈瑟氏腦膜炎球菌（Neisseria meningitidis）

D. 單核球增多性李斯特菌（Listeria monocytogenes）


Question: 大部份血管瘤（hemangioma）在多少歲開始退化？

Answer: 12～18個月

A. 1個月

B. 3～6個月

C. 6～9個月

D. 12～18個月


Question: 19 一位 40 歲男性，曾經因肝功能異常接受血液檢查，被告知結果為 anti-HDV 呈現陽性反應，這位病人最可能當時還有以下何種病毒感染？（HDV 表示 D 型肝炎病毒）

Answer: B 型肝炎病毒

A. A 型肝炎病毒

B. B 型肝炎病毒

C. C 型肝炎病毒

D. E 型肝炎病毒


Question: Pyrazinamide 在酸性環境中可有效對抗結核桿菌的活性，故常與其他藥物合併使用以治療結核病患，但該抗生素真正有活性的形式是必須被水解成 pyrazinoic acid。此水解反應需在何器官進行？

Answer: 肝臟

A. 心臟

B. 肝臟

C. 腎臟

D. 脾臟


Question: 1歲以上正常小孩應仍保有下列那一種反應或反射？

Answer: parachute reaction

A. palmar grasp reflex

B. parachute reaction

C. rooting reflex

D. symmetric tonic neck reflex（STNR） 72.


Question: 下列有關遲發型性腺功能低下症（late onset hypogonadism）的敘述，何者正確？

Answer: 有臨床症狀時才須治療

A. 睪固酮於晚上 8 至 10 點分泌達最高峰

B. 睪固酮由睪丸內曲細精管內皮細胞分泌

C. 有臨床症狀時才須治療

D. 前列腺增生（BPH）病人可以補充睪固酮


Question: 不產芽孢厭氧菌（non-sporeforming anaerobes）感染人體，最常造成下列那種形式的病變？

Answer: 組織壞死和膿瘍（abscess）

A. 食物中毒（food poisoning）

B. 溶血性貧血（hemolytic anemia）

C. 組織壞死和膿瘍（abscess）

D. 自體免疫病（autoimmune diseases）


Question: 18 75 歲王先生，因高血壓服藥控制，血壓為 130/70 mmHg。三天前因攝護腺肥大，併服泌尿科開予的 α-blocker，早上起床時發生昏厥（syncope），2 分鐘後自然甦醒。家屬並未發現有尿、糞失禁現象。 病人昏厥最可能的原因為何？

Answer: 姿勢性低血壓（orthostatic hypotension）

A. 姿勢性低血壓（orthostatic hypotension）

B. 心室顫動（ventricular fibrillation）

C. 心因性休克（cardiogenic shock）

D. 癲癇發作（seizure）


Question: ⼀位61歲男性⻑期使⽤diazepam每天50～60毫克達15年，若立即停⽌服⽤後，下列何者為最正確的描述？

Answer: 抽搐發作為較嚴重之戒斷症狀

A. ⼼搏變慢

B. 戒斷症狀不會在停⽤5天後才出現

C. 抽搐發作為較嚴重之戒斷症狀

D. 戒斷症狀不致於產⽣譫妄


Question: 73.15歲車禍傷患主訴左上腹部劇痛，而且逐漸呈現休克狀態。電腦斷層檢查如附圖。箭頭所指之異常最符合下列那一項診斷？

Answer: spleen laceration

A. spleen laceration

B. pancreas laceration

C. kidney laceration

D. diaphragm laceration


Question: 免疫球蛋白重鏈（immunoglobulin heavy chain）基因之胚原序列（germline sequence）可存在於下列那種細胞中？

Answer: T 細胞

A. 成熟之 B 細胞

B. 活化之 B 細胞

C. 漿細胞（plasma cell）

D. T 細胞


Question: Celiac disease及Crohn's disease是二種腸道發炎疾病，下列有關二者之比較何者正確？

Answer: IFN-γ所引起的發炎反應，在這二種疾病都扮演重要角色

A. 前者是對腸內共生菌有強烈發炎反應，後者是因為對麥類食物過敏所引起

B. 前者可能與NOD-2分子失去功能有關，後者主要與HLA-DQ2分子的表現有關

C. IFN-γ所引起的發炎反應，在這二種疾病都扮演重要角色

D. 利用廣泛性抗生素去掉大部分共生菌，皆可治療這二種疾病


Question: 77.下列有關單胞絛蟲（Echinococcus granulosus）感染人體的敘述，共有幾項敘述錯誤？①人為終宿主（final host） ②最容易在肌肉形成包生囊（hydatid cyst） ③因誤食未熟帶蟲之牛肉而感染 ④感染後數週即迅速發病

Answer: 4項

A. 1項

B. 2項

C. 3項

D. 4項


Question: 58 35 歲之女性病人，主訴心悸，容易緊張，體重在半年內減輕 10 公斤。理學檢查發現手易發抖、冒汗。 頸部甲狀腺吞嚥時易見。甲促素（TSH）測不到。下列何者是確定本病例病因之最重要檢查？

Answer: 甲狀腺碘 131 攝取影像檢查

A. 甲狀腺超音波

B. 甲狀腺碘 131 攝取影像檢查

C. 細針穿刺細胞學檢查

D. 頸部斷層攝影


Question: 下列口服降血糖藥物中，不會引起體重增加的是那一種？

Answer: metformin

A. glyburide

B. metformin

C. pioglitazone

D. repaglinide


Question: 乳癌最常見轉移部位為下列何者？

Answer: 骨骼

A. 腦部

B. 骨骼

C. 肺部

D. 肝臟


Question: 腰椎椎間盤突出，90%發生在那個地方？

Answer: L4-5 and L5-S1

A. L1-2 and L2-3

B. L2-3 and L3-4

C. L3-4 and L4-5

D. L4-5 and L5-S1


Question: 單純以加氯消毒飲用水，對下列那一種病原體效果不佳？

Answer: 梨型鞭毛蟲（Giardia）

A. 梨型鞭毛蟲（Giardia）

B. 沙門桿菌（Salmonella）

C. 志賀桿菌（Shigella）

D. 大腸桿菌（Esherichia Coli）


Question: 下列有關白血病（leukemia）各器官病理變化之敘述，何者錯誤？

Answer: 慢性淋巴球性白血病（chronic lymphoid leukemia）之肝臟浸潤在於肝竇狀隙內

A. 急性骨髓性白血病（acute myeloid leukemia）中單核球分化之亞型較可能浸潤皮膚及其附屬構造

B. 急性淋巴球性白血病（acute lymphoid leukemia）比急性骨髓性白血病較常見有中樞神經

C. 綠色瘤（chloroma）多會進展為急性骨髓性白血病

D. 慢性淋巴球性白血病（chronic lymphoid leukemia）之肝臟浸潤在於肝竇狀隙內


Question: 有關心電圖PR間距（PR interval），最不可能代表下列心跳週期的那一部分？

Answer: 心室去極化（ventricular depolarization）

A. 心房去極化（atrial depolarization）

B. 心房再極化（atrial repolarization）

C. 房室間細胞延遲（atrioventricular delay）

D. 心室去極化（ventricular depolarization）


Question: 下列何者非葡萄球菌菌種（Staphylococcus species）所造成的主要疾病？

Answer: 胃潰瘍（gastric ulcer）

A. 食物中毒（food poisoning）

B. 膿皰瘡（impetigo）

C. 皮膚燙傷樣綜合徵狀（scalded skin syndrome）

D. 胃潰瘍（gastric ulcer）


Question: 關於梅毒的敘述，下列何者正確？

Answer: 二期梅毒皮疹典型發生在chancre出現的3~12週後，但在HIV病患出現的時間可能與chancre有所重疊

A. 梅毒螺旋體（Treponema pallidum）可以利用鏡檢與其他nonvenereal diseases的treponemes做鑑別診斷

B. 二期梅毒皮疹經治療後，皮疹通常在4~12週後消褪

C. 二期梅毒皮疹典型發生在chancre出現的3~12週後，但在HIV病患出現的時間可能與chancre有所重疊

D. 血液專一性treponemal test是監測梅毒治療效果的最佳指標


Question: 77 在治療注意力缺損過動疾患（attention-deficit/hyperactivity disorder）之患者，常使用中樞神經刺激劑 （central stimulants），下列何者不屬此類藥物？

Answer: Nortriptyline

A. Dextroamphetamine

B. Methylphenidate

C. Nortriptyline

D. Pemoline


Question: 塵肺病中與惡性間皮瘤（malignant mesothelioma）最相關的物質是：

Answer: 石綿

A. 碳

B. 鉛

C. 矽

D. 石綿


Question: 下列那個現象最能顯示 DNA 為遺傳物質？

Answer: DNA 的轉化作用（transformation）能改變細菌的表型（phenotype）

A. RNA 的生物合成必須以單股 DNA 做為模版

B. DNA 的轉化作用（transformation）能改變細菌的表型（phenotype）

C. DNA 存在於原核生物中

D. DNA 存在於所有的真核的細胞核中


Question: 下列有關抗癲癇藥物oxcarbazepine的敘述，何者錯誤？

Answer: 其比carbamazepine具有較強的誘發肝臟細胞色素P450活性的作用

A. 主要靠其代謝物10-hydroxy-carbazepine（MHD）來產生抗癲癇作用

B. 其藥理學作用方式與carbamazepine相似，但相對嚴重的副作用較少發生

C. 其比carbamazepine具有較強的誘發肝臟細胞色素P450活性的作用

D. 使用oxcarbazepine較carbamazepine容易發生低鈉血症（hyponatremia）


Question: 老化過程中會發生許多生理變化，在 80 歲以上之正常老人，下列何種變化不正確或較罕見？

Answer: 腎素（renin）與腎上腺皮質醛固酮（aldosterone）分泌增加

A. 心臟竇房結（sino-atrial node）之節律細胞（pacemaker cells）數量減少可達 90%

B. 腎素（renin）與腎上腺皮質醛固酮（aldosterone）分泌增加

C. 約有 50%可在腸道發現憩室（diverticula）

D. 動脈血氧分壓約 70-75 毫米汞柱 21 	下列何者在老年病患最不常見？


Question: 下列何者會因小腸中出現酸性食糜而分泌？

Answer: 胰泌素（secretin）

A. 胃抑素（gastric inhibitory polypeptide）

B. 胃泌素（gastrin）

C. 飢餓素（ghrelin）

D. 胰泌素（secretin）


Question: 下列何者不屬於深筋膜（deep fascia）的構造？

Answer: 半月板（meniscus）

A. 闊筋膜（fascia lata）

B. 半月板（meniscus）

C. 髂脛束（iliotibial tract）

D. 足底筋膜（plantar aponeurosis）


Question: S-D 序列（Shine-Dalgarno sequence）是位於 mRNA 轉譯起點（translation initiation site）上游的 AG 豐富序列（AG rich sequence），其功能為何？

Answer: 可與 16S 核糖體 RNA 的 3'端序列結合，使 mRNA 的轉譯起點作正確排列以利轉譯表現的進行

A. 可與 23S 核糖體 RNA（ribosomal RNA）的 3'端序列結合，使 mRNA 上的啟動子區域（promoter region）作正確排列以利轉譯表現的進行

B. 可與 16S 核糖體 RNA 的 3'端序列結合，使 mRNA 上的啟動子區域作正確排列以利轉譯表現的進行

C. 可與 23S 核糖體 RNA 的 3'端序列結合，使 mRNA 的轉譯起點作正確排列以利轉譯表現的進行

D. 可與 16S 核糖體 RNA 的 3'端序列結合，使 mRNA 的轉譯起點作正確排列以利轉譯表現的進行


Question: 34.以下有關hereditary nonpolyposis colon cancer（HNPCC；或稱Lynch's syndrome）常見的臨床病理及基因分子 變異，何者錯誤？

Answer: HNPCC大腸直腸癌患者診斷的中位年齡，較其他一般民眾大腸直腸癌診斷的中位年齡來得較年長

A. HNPCC大腸直腸癌患者診斷的中位年齡，較其他一般民眾大腸直腸癌診斷的中位年齡來得較年長

B. HNPCC患者的家屬也好發卵巢癌、子宮內膜癌或其他的腸胃道癌症

C. HNPCC與germline mutations of hMSH2或hMLH1相關

D. hMSH2或hMLH1之基因變異將導致細胞內DNA mismatch repair機制的缺損


Question: 下列何者不是腹膜（peritoneum）的衍生物？

Answer: 卵巢韌帶

A. 闊韌帶

B. 卵巢繫膜

C. 卵巢韌帶

D. 輸卵管繫膜


Question: 有關溺水病人之急救，下列何者正確？

Answer: 最重要的病理性結果是缺氧

A. 最重要的病理性結果是缺氧

B. 應儘早清除呼吸道的水分，儘速實施哈姆立克急救

C. 應使用提下巴法打開呼吸道，且常規使用頸圈於每位溺水病患

D. 急救溺水的病人，應從水中就開始做 CPR，然後一面游向岸邊


Question: 抑制單純疹病毒之藥物 acyclovir，其標的為何？

Answer: 病毒胸腺激酶（thymidine kinase）

A. 直接破壞病毒的組成，造成病毒結構解離

B. 阻止病毒從寄主細胞中釋放出來

C. 病毒胸腺激酶（thymidine kinase）

D. 抑制病毒 RNA 合成酶（RNA polymerase）的作用


Question: 下列甲狀腺結節（thyroid nodule）的檢查，應不優先考慮何者？

Answer: 正子攝影檢查

A. 超音波及細針穿刺細胞檢查

B. 胸骨下甲狀腺瘤作CT或 MRI

C. 正子攝影檢查

D. 甲狀腺核醫掃描（scanning）用於濾泡瘤且甲狀腺刺激素（TSH）低者


Question: 比較第一型和第二型骨骼肌纖維時，下列何者錯誤？

Answer: 第一型纖維較易疲乏

A. 第一型纖維的粒線體含量較豐富

B. 第一型纖維較易疲乏

C. 第一型纖維的肌球蛋白含量較豐富

D. 第一型纖維的微血管含量較豐富


Question: 這位病人可能是因下列何構造被血塊擠壓，進而壓迫腦幹而引起上述症狀？

Answer: 鉤（uncus）

A. 小腦扁桃體（cerebellar tonsil）

B. 鉤（uncus）

C. 胼胝體（corpus callosum）

D. 下視丘（hypothalamus）


Question: 78 一位 72 歲男性在周邊血液出現有核紅血球。病人之直接及間接抗球蛋白測試（direct and indirect  Coombs test）均為陰性。下列何者為最可能之原因？

Answer: 癌症骨髓轉移

A. 癌症骨髓轉移

B. 慢性酒精中毒

C. 腸胃吸收不良

D. 慢性失血


Question: 23 一位 15 歲女孩來到門診，主訴發燒 3 週、體重減輕、全身倦怠，身體診查發現雙側臉頰紅斑。在懷疑 systemic lupus erythematosus 情形下，下列何種檢查結果符合美國風濕病學院（ACR）公布的十一 項診斷準則之一？

Answer: positive anticardiolipin IgG and IgM

A. 淋巴球 2200/mm3

B. 24 小時肌酐廓清率（creatinine clearance rate）45 ml/min/1.73 m2

C. positive anticardiolipin IgG and IgM

D. 補體 C3：60 mg/dL, C4：9.87 mg/dL


Question: 下列對於「脾臟之紅髓（red pulp）」的敘述，何者正確？

Answer: 富含血液

A. 由淋巴小結（lymphatic nodule）組成

B. 位於皮質區

C. 富含血液

D. 主要功能是過濾淋巴液


Question: 病人發生代謝性酸血症（Metabolic acidosis）合併下列何種臨床情境，則可能為Inborn errors of metabolism 的機率最高？

Answer: 3週大新生兒，一直嘔吐、無法進食、活力差。血液Anion gap與Lactic acid增加；尿液Ketones 4+

A. 3週大新生兒，一直嘔吐、無法進食、活力差。血液Anion gap與Lactic acid增加；尿液Ketones 4+

B. 10個月大男嬰持續腹瀉3天。血液呈現氯高而Anion gap正常

C. 3歲大男童高燒5天且食慾差。血液白血球增高

D. 8歲女童多吃、多喝、多尿但體重下降。血糖410 mg/dL，血液呈現Anion gap增加


Question: 45歲孕婦，G5P4，妊娠週數不明，接受產科超音波檢查，正在測量標的的名稱（雙十	之間）為何？

Answer: FL（femur length）

A. BPD（biparietal diameter）

B. AC（abdominal circumference）

C. FL（femur length）

D. NT（nuchal translucency）


Question: ⼤部分⼈體內成熟T細胞上之TCR為α-chain及β-chain所組成，故稱為αβ T cells。當比對TCR α-chain及βchain的DNA序列時，發現β-chain比α-chain多出了下列何種基因片段？

Answer: D

A. V

B. D

C. J

D. C


Question: 下列何者直接位於子宮的後方？

Answer: 輸卵管

A. 卵巢

B. 膀胱

C. 直腸

D. 輸卵管


Question: 65 下列何者為心臟復健的目的？①治療心臟病 ②增進心臟功能 ③減少殘障發生 ④找出並改善危 險因子

Answer: ①②③④

A. 只有①和②

B. 只有③和④

C. 只有①②③

D. ①②③④


Question: 下列有關房水（aqueous humour）之敘述，何者錯誤？

Answer: 房水在前房形成，經瞳孔，流入後房排出

A. 房水是血漿在睫狀體（cilicary body）處分泌（secretion）形成

B. 大約90%的房水經小樑網（trabecular meshwork）排出眼睛

C. 大約10%的房水經葡萄膜鞏膜路徑（uveoscleral route）排出眼睛

D. 房水在前房形成，經瞳孔，流入後房排出


Question: α-胺基酸中的胺基（-NH2）與羧基（-COOH），其 pKa 值分別為 10 和 2，當 pH 接近中性時，胺基會接受一個質子（proton），而羧基則失去一個質子，這種狀態或現象稱為：

Answer: 兩性離子（zwitterions）

A. 異構現象（isomerization）

B. 中和現象（neutralization）

C. 兩性離子（zwitterions）

D. 立體異構現象（stereoisomerization）


Question: 關於兒童失神癲癇 （childhood absence epilepsy）的敘述，下列何者正確？

Answer: 屬於良性的原發性全面性癲癇（idiopathic generalized epilepsy）之一

A. 好發於1至3歲

B. 常伴有智力損傷或神經學檢查異常

C. 每秒4到6次的棘波-慢波複合波（4-to 6-Hz spike-and-wave complexes）為其特徵性之腦電圖（EEG）表現

D. 屬於良性的原發性全面性癲癇（idiopathic generalized epilepsy）之一


Question: 鐵硫蛋白（iron-sulfur protein）為一種電子傳遞蛋白質，下列相關敘述何者不正確？

Answer: 有 3Fe-3S cluster

A. 屬於 non-heme iron protein

B. 其鐵硫簇（iron-sulfur cluster）的配體（ligand）大多是 cysteine

C. Rieske protein 屬於此類的蛋白

D. 有 3Fe-3S cluster


Question: 下列何者是食道異物（esophageal foreign body）最容易卡住的部位？

Answer: 環咽括約肌（cricopharyngeal sphincter）狹窄區

A. 環咽括約肌（cricopharyngeal sphincter）狹窄區

B. 主動脈跨過食道造成狹窄區

C. 食道中三分之一處

D. 下食道括約肌（lower esophageal sphincter）狹窄區


Question: 73.13歲女性病患，月經未來且下腹痛，故接受電腦斷層檢查，結果如下圖。其最有可能的診斷為何？

Answer: 子宮融合異常合併處女膜未穿孔（uterine fusion abnormality with imperforated hymen）

A. 子宮肌瘤（uterine myoma）

B. 子宮內膜癌（endometrial cancer）

C. 輸卵管卵巢膿瘍（tubo-ovarian abscess）

D. 子宮融合異常合併處女膜未穿孔（uterine fusion abnormality with imperforated hymen）


Question: 有關肝醣合成酶（glycogen synthase）參與肝醣合成之敘述，下列何者正確？

Answer: 將葡萄糖殘基以（α1→4）鍵結⾄肝醣鏈（glycogen chain）之非還原端

A. 此酵素被磷酸化後可被活化

B. 此酵素只存在於肝臟

C. 利⽤glucose-6-phosphate做為葡萄糖單元的供給者

D. 將葡萄糖殘基以（α1→4）鍵結⾄肝醣鏈（glycogen chain）之非還原端


Question: 處理急性胸痛病患時，下列何項應為第一優先執行？

Answer: 呼吸、脈搏、血壓

A. 呼吸、脈搏、血壓

B. 病史

C. 身體檢查

D. 心電圖


Question: 48 如圖示，未施打顯影劑之電腦斷層橫切面影像，於右大腦半球額頂葉處，有一大範圍之低密度病灶 ，並使中線構造左移，最可能的診斷為下列何者？

Answer: 腦梗塞（cerebral infarct）

A. 腦炎（encephalitis）

B. 腦梗塞（cerebral infarct）

C. 腦挫傷（brain contusion）

D. 腦瘤（brain tumor）


Question: 下列那一項不是影響子宮內膜癌的不良預後因子？

Answer: 年輕

A. 深部子宮肌肉層侵襲

B. grade 3 腫瘤

C. 年輕

D. 淋巴血管空間侵襲（lymph-vascular space invasion）


Question: 依照衛生福利部國民健康署的乳癌篩檢建議，健康年齡 55 歲的停經女性，定期追蹤項目為下列何者？

Answer: 每兩年乳房 X 光攝影

A. 每半年執行乳房超音波檢查

B. 每年乳房 X 光攝影

C. 每一年乳房超音波檢查

D. 每兩年乳房 X 光攝影


Question: 治療慢性腎病（chronic kidney disease）合併之高血壓時，首選藥物為：

Answer: 血管張力素轉化酶阻斷劑（angiotensin-converting enzyme inhibitors）或血管張力素接受器阻斷劑（angiotensin receptor blockers）

A. 利尿劑（diuretics）

B. 鈣離子阻斷劑（calcium channel blockers）

C. β-阻斷劑（β-blockers）

D. 血管張力素轉化酶阻斷劑（angiotensin-converting enzyme inhibitors）或血管張力素接受器阻斷劑（angiotensin receptor blockers）


Question: 急性膽管炎指的是膽道系統細菌性感染，臨床症狀從輕微自癒到危及生命都有可能，何者非Charcot's  triad？

Answer: 意識譫妄（delirium）

A. 發燒（fever）

B. 黃疸（jaundice）

C. 腹痛（abdominal pain）

D. 意識譫妄（delirium）


Question: 關於腎小管對於腎小球過濾液中鈉離子再吸收的描述，下列何者錯誤？

Answer: 亨氏管上行段粗枝的基底外側細胞膜會利用鈉-鉀-氯協同轉運蛋白（Na-K-2Cl cotransporter）再吸收 30%腎小球過濾液中的鈉離子

A. 60%腎小球過濾液中的鈉離子在近曲小管被再吸收

B. 亨氏管上行段粗枝的基底外側細胞膜會利用鈉-鉀-氯協同轉運蛋白（Na-K-2Cl cotransporter）再吸收 30%腎小球過濾液中的鈉離子

C. 遠曲小管（distal convoluted tubule）會利用頂膜（apical membrane）的鈉-氯協同轉運蛋白（Na-Cl cotransporter）再吸收 7%腎小球過濾液中的鈉離子

D. 集尿管（collecting duct）會利用頂膜的上皮鈉離子通道（epithelial sodium channel）再吸收 3%腎小球過濾液中的鈉離子


Question: 下列那一個胺基酸可以代謝成α-ketoglutarate，然後進入 citric acid cycle？

Answer: Proline

A. Glycine

B. Proline

C. Alanine

D. Tyrosine


Question: 神經傳遞中下列那一項可能最直接促使神經末梢之乙醯膽鹼（acetylcholine）釋放？

Answer: 電壓門控鈣離子通道（voltage-gated calcium ion channel）打開

A. 電壓門控鈉離子通道（voltage-gated sodium ion channel）打開

B. 電壓門控鉀離子通道（voltage-gated potassium ion channel）打開

C. 電壓門控鈣離子通道（voltage-gated calcium ion channel）打開

D. 電壓門控鎂離子通道（voltage-gated magnesium ion channel）打開 50 請指出何者不是核糖核酸（ribonucleic acid, RNA）的特性？


Question: 根據世界醫學會所制定的赫爾辛基宣言（Declaration of Helsinki），對兼顧醫療照護的醫學研究，下列建議何者最為適當？

Answer: 醫師可以結合醫學研究與醫療照護，但此情況僅止於此研究有潛在的預防、診斷或治療的價值

A. 應清楚區分醫療照護與醫學研究，以避免責任不清，確保病患權益

B. 研究是提升醫療照護水準所必需，因此在教學醫院，所有的醫療照護都應包含某種程度之醫學研究

C. 醫師可以結合醫學研究與醫療照護，但此情況僅止於此研究有潛在的預防、診斷或治療的價值

D. 無相關建議


Question: 如果以員工「對工作的自主控制」（control）及「工作負荷」（demand）來分類，以下何種組合的職業壓力最高？

Answer: 低控制、高負荷

A. 高控制、高負荷

B. 高控制、低負荷

C. 低控制、低負荷

D. 低控制、高負荷


Question: 甲狀腺上皮細胞內將碘化甲狀腺球蛋白（iodinated thyroglobulin）分解成甲狀腺素的胞器是：

Answer: 溶酶體（lysosomes）

A. 溶酶體（lysosomes）

B. 過氧化酶體（peroxisomes）

C. 粒線體（mitochondria）

D. 高爾基氏體（Golgi complex）


Question: 22 一位 16 歲男性，體檢時發現胸部 X 光肺動脈血管陰影擴大，心臟大小正常，理學檢查聽診在左邊第 肋間有 2/6 度收縮期心雜音，第 2 心音呈固定分裂音（fixed splitting），則最可能的診斷是：

Answer: 心房中隔缺損

A. 肺動脈瓣狹窄

B. 主動脈瓣狹窄

C. 心室中隔缺損

D. 心房中隔缺損


Question: 77.一位56歲女性，由美國紐約返回臺北的飛機途中發生暈厥（syncope），下了飛機後因呼吸不順至急診就 診，她以前不曾發生類似狀況，平常亦無特殊疾病，身體檢查發現血壓120/70 mmHg，心跳126次/分，呼吸 28次/分，體溫37.2℃，呼吸音及心音皆正常，四肢活動自如，無腫脹現象，在給予40％氧氣五分鐘後，動脈氣體分析為pH=7.48，PaO2 =70mmHg，PaCO2 =28mmHg，O2 saturation=92%，此時應安排下列那一項檢查最適當？

Answer: 注射顯影劑的螺旋快速胸部電腦斷層檢查

A. 心臟超音波檢查

B. 靜脈杜卜勒超音波檢查

C. 注射顯影劑的螺旋快速胸部電腦斷層檢查

D. 主動脈血管攝影


Question: 外傷評分系統（Injury Severity Score, ISS）是對外傷病患嚴重度評估常⽤的評分⽅式；下列對於外傷評分系統的敘述何者錯誤？

Answer: Injury Severity Score（ISS）是⼀種⽣理性評分系統（physiological scoring system）

A. Abbreviated Injury Scale（AIS），於1971年提出，將受傷部位嚴重程度，分為從第1級（minimal severity）⾄第6級（presumably fatal）

B. Injury Severity Score（ISS）是⼀種⽣理性評分系統（physiological scoring system）

C. ISS分數區域為1分⾄75分，minor injury是指ISS<9分

D. Glasgow Coma Scale（GCS）能評量外傷病患意識狀態，分數區域為3分⾄15分


Question: 有關氣喘病患呼吸道過度反應性（airway hyperresponsiveness）之敘述，下列何者錯誤？

Answer: 某病患methacholine PC20<8 mg/mL即可診斷為氣喘

A. 常以支氣管激發試	中使FEV1下降20%之methacholine濃度（PC20）或劑量（PD20）來表示

B. 如果某病患methacholine劑量-反應曲線在高劑量時未出現平原（plateau）現象也代表呼吸道高反應性之存在

C. 某病患methacholine PC20<8 mg/mL即可診斷為氣喘

D. methacholine PC20值越低代表呼吸道高反應性越高


Question: 主動脈瓣狹窄的病患容易發生心絞痛（angina pectoris）的原因為何？

Answer: 左心室壓增加但是主動脈壓卻下降

A. 左心室壓增加而且主動脈壓也增加

B. 左心室壓增加但是主動脈壓卻下降

C. 左心室壓下降而且主動脈壓也下降

D. 左心室壓下降但是主動脈壓卻增加


Question: 對於肝硬化的敘述，下列何者錯誤？

Answer: 預防肝硬化所引起的食道靜脈瘤的首選藥物為非選擇性α-blockers

A. 經頸靜脈肝內門體靜脈分流術TIPS（transjugular intrahepatic portosystemic shunt） 會使得肝性腦病變

B. 預防肝硬化所引起的食道靜脈瘤的首選藥物為非選擇性α-blockers

C. 不論是否伴隨	出血，末期肝衰竭病患都需考慮肝臟移植

D. 食道靜脈瘤出血處置需要外科介入的情況，包含內視鏡處理失	，胃靜脈瘤出血和TIPS治療失


Question: 下列何者不是綠膿桿菌（Pseudomonas aeruginosa）的特徵？

Answer: 會發酵葡萄糖和乳糖

A. 好棲息於潮濕的環境中

B. 會發酵葡萄糖和乳糖

C. 生長時會發出葡萄般的香味

D. 對大部分的抗生素具抗藥性


Question: 當偏頭痛患者出現噁⼼、嘔吐等症狀時，下列何者是最佳的治療藥物？

Answer: sumatriptan

A. acetaminophen

B. allopurinol

C. sumatriptan

D. sulindac


Question: 肺炎退伍軍人桿菌（Legionella pneumophila）初次分離培養（primary culture）時，需要添加下列那種成分？

Answer: L-半胱胺酸（L-cysteine）

A. 甘油（glycerol）

B. 橄欖油（olive oil）

C. L-半胱胺酸（L-cysteine）

D. 菸鹼酸（nicotinic acid）


Question: 相較於年輕人，老年人之甲狀腺機能亢進，比較容易以下列何種徵象來表現？

Answer: 心房纖維顫動（atrial fibrillation）

A. 凸眼（exophthalmos）

B. 心房纖維顫動（atrial fibrillation）

C. 甲狀腺腫（goiter）

D. 震顫（tremor）


Question: 色素性視網膜炎（retinitis pigmentosa）的典型三特徵（classical triad）不包含：

Answer: 黃斑部水腫（macular edema）

A. 骨刺狀黑色素沉積（retinal bone-spicule pigmentation）

B. 視神經蒼白化（waxy pallor of the optic disc）

C. 小動脈變細（arteriolar attenuation）

D. 黃斑部水腫（macular edema）


Question: 下列何項是分辨高位無肛病（high type imperforate anus）或低位無肛病（low type imperforate anus）最重要的方法？

Answer: 肉眼觀察

A. 倒位攝影（invertogram）

B. 電腦斷層

C. 核磁造影

D. 肉眼觀察


Question: 有關免疫抑制劑的敘述，下列何者錯誤？

Answer: Sirolimus（Rapamycin）和 Cyclosporine 都屬於 Calcineurin inhibitors

A. Tacrolimus 造成的 PTDM（Post-transplant diabetes mellitus）機會比 Cyclosporine 高

B. Cyclosporine 會有牙齦增生（Gingival hyperplasia）和多毛症（Hirsutism）的副作用

C. Sirolimus（Rapamycin）和 Cyclosporine 都屬於 Calcineurin inhibitors

D. Tacrolimus 和 Cyclosporine 都是常用於腎臟移植術後的藥物，但是同時也具有腎毒性的副作用


Question: 關於蕁麻疹（urticaria）的敘述，下列何者錯誤？

Answer: 病灶的組織病理變化主要是血管炎

A. 肥胖細胞（mast cell） 是主要作用細胞

B. 特定病灶存在時間通常小於24小時

C. 部分慢性蕁麻疹患者的病因是自體免疫（autoimmunity）

D. 病灶的組織病理變化主要是血管炎


Question: 一位 55 歲男性主訴解黑便 3 天，內視鏡檢查發現為十二指腸潰瘍，除了制酸藥劑 Omeprazole 外，有醫師建議給予口服 Clarithromycin 250 mg 及 Amoxicillin 1000 mg 每天兩次。服用幾天是最佳選擇？

Answer: 14 天

A. 3 天

B. 14 天

C. 30 天

D. 90 天


Question: 上頜 Le Fort 式骨折一共有幾種？

Answer: 三

A. 一

B. 二

C. 三

D. 四


Question: 下列何者是臨床上已廣泛用來抑制攝護腺肥大及治療雄性禿之 5α-reductase type 2 inhibitor？

Answer: Finasteride

A. Finasteride

B. Dutasteride

C. Megestrol acetate

D. Leuprolide


Question: 在昏暗的環境下，視網膜桿狀細胞（rod cell）外部區段（outer segment）產生的鈉離子內流（influx）電流主要是因為下列那一物質的作用？

Answer: cGMP

A. cAMP

B. cGMP

C. 傳導素（transducin）

D. all-trans retinal


Question: 頸脊髓空洞症（cervical syringomyelia）最典型的臨床症狀是：

Answer: 區段分離性的感覺異常症候群（segmental sensory dissociation）

A. 區段分離性的感覺異常症候群（segmental sensory dissociation）

B. 分離性感覺與運動障礙症候群（sensory motor dissociation deficit）

C. 聯合性後柱及側柱障礙症候群（combined posterior and lateral column deficit）

D. 聯合性前柱及側柱障礙症候群（combined anterior and lateral column deficit）