一○四年度內專筆試題

一○四年度內科專科醫師考試筆試題 -- 免疫科

(B) 1. 下列有關specific autoantibody與自體免疫疾病的配對中，何者最正確？

A. Anti-collagen type II--Goodpasture's syndrome

B. Anti-aminoacyl-tRNA histidyl synthetase--Myositis

C. Anti-thyroid peroxidase--Graves' disease

D. Anti-myeloperoxidase--Granulomatosis with polyangiitis

E. Anti-keratin--SLE

(A) 2. 一位23歲女性，從5歲開始皮膚持續發癢至今。就診時臉部、頸部、背部、腹部及四肢皮膚已呈苔癬化(lichenification)。請問對本患者最有用的檢查項目為：

A. Serum specific IgE

B. Dermatography

C. Total eosinophil count

D. Serum complement C1 inhibitor levels

E. Skin pathology

(E) 3. 一位26歲的SLE患者過去曾有3次流產紀錄，請問與下列的何種自體抗體最有相關？

A. Anti-dsDNA

B. Anti-SSA/Ro

C. Anti-Sm

D. Anti-histone

E. Anti-phospholipid

(C) 4. 41歲的女性來院求診的主訴為手、腳多處關節痠痛有三年之久。最近二個月來發現左手第2、3指的近端指間關節腫脹.在診所抽血檢查發現：ESR 32 mm/h、CRP 1.8 mg/dL、C3 89 mg/dL及C4 17.1 mg/dL，請問下列的何種檢查，對診斷類風濕性關節炎最有幫助？

A. Rheumatoid factors

B. ANAs

C. Anti-CCP antibodies

D. Bilateral hand X-ray examination

E. Bilateral hand sonographic examination

(E) 5. 48歲女性發現近三年來兩側手指在冬天會變白及變紫，經保暖之後會恢復。最近覺得吞嚥有點困難，及發現雙側手指的皮膚變厚、變硬。請問下列的何種檢查對診斷systemic sclerosis最有幫忙？

A. Anti-U1RNP

B. Nailfold capillaroscopy

C. Pulmonary function test + DLCO

D. Anti-centromere antibody

E. Anti-topoisomerase-1

(D) 6. 68歲的男性患者在15年前因兩手肘及頭皮皮膚病變，被皮膚科醫師診斷為"乾癬"，經治療之後皮膚症狀穩定。最近一個月來發現兩手多指的遠端指間關節腫脹疼痛。而且有多根手指變成"香腸指樣"(sausage-like finger)。抽血檢查發現ESR 48 mm/1h、CRP 3.8 mg/dL、Rheumatoid factor 14.3 IU/ml (normal < 10 IU/ml)、uric acid 8.1 mg/dL，X-光檢查發現手部遠端指間關節有破壞變型。因另有腰部痠痛經pelvic X-ray檢查發現S-I關節有明顯發炎反應，請問最有可能的診斷為：

A. Rheumatoid arthritis

B. Gouty arthritis

C. Osteoarthritis

D. Psoriatic arthropathy

E. Ankylosing spondylitis

(B) 7. 下列有關治療風濕病/自體免疫疾病的藥物與其副作用的配對中，在臨床上何者最為嚴重？

A. Glucocorticoids--leukocytosis

B. Azathioprine--neutropenia

C. Methotrexate--oral mucosal ulcer

D. Intravenous cyclophosphamide pulse therapy-teratogenicity

E. Hydroxychloroquine--retinal detachment

(C) 8. Rheumatoid arthritis的關節外的臨床表徵很多，下列的何種組合最為正確？(1) keratoconjunctivitis sicca (2) iritis/uveitis (3) periodontitis (4) cerebral vasculitis (5) 頸椎C1-C2 subluxation (6) pleuritis (7) renal tubular acidosis (8) cutaneous vasculitis (9) thrombocytopenia (10) intestinal mucositis

A. (1)+(4)+(7)

B. (4)+(6)+(7)

C. (1)+(5)+(6)

D. (3)+(5)+(7)

E. (2)+(9)+(10)

(D) 9. 血管炎症候群(vasculitis syndrome)的標幟抗體為ANCA，請問下列那些血管炎是ANCA(+) vasculitis？(1) drug-induced vasculitis (2) granulomatosis with polyangiitis (3) cancer-associated vasculitis (4) Churg-Strauss syndrome (5) Behcet's disease (6) microscopic polyangiitis (7) Kawasaki disease (8) idiopathic crescentic glomerulonephritis (9) giant cell arteritis (10) polyarteritis nodosa

A. (1)+(3)+(5)+(7)

B. (1)+(2)+(3)+(4)

C. (2)+(5)+(6)+(7)

D. (2)+(4)+(6)+(8)

E. (3)+(8)+(9)+(10)

(B) 10. Chronic polyarthritis可以包括下列何種疾病？(1) gouty arthritis (2) rheumatoid arthritis (3) pyogenic arthritis (4) calcium pyrophosphate deposition disease (5) osteoarthritis (6) Lyme arthritis (7) pigmented villonodular synovitis (8) reactive arthritis (9) hemophilic hemarthrosis (10) sarcoidosis

A. (1)+(2)+(3)

B. (2)+(5)+(10)

C. (3)+(5)+(9)

D. (4)+(6)+(8)

E. (5)+(7)+(8)

< 一○四年度試題目錄 >

(B)	1.	下列有關specific autoantibody與自體免疫疾病的配對中，何者最正確？
		A.	Anti-collagen type II--Goodpasture's syndrome
		B.	Anti-aminoacyl-tRNA histidyl synthetase--Myositis
		C.	Anti-thyroid peroxidase--Graves' disease
		D.	Anti-myeloperoxidase--Granulomatosis with polyangiitis
		E.	Anti-keratin--SLE

(A)	2.	一位23歲女性，從5歲開始皮膚持續發癢至今。就診時臉部、頸部、背部、腹部及四肢皮膚已呈苔癬化(lichenification)。請問對本患者最有用的檢查項目為：
		A.	Serum specific IgE
		B.	Dermatography
		C.	Total eosinophil count
		D.	Serum complement C1 inhibitor levels
		E.	Skin pathology

(E)	3.	一位26歲的SLE患者過去曾有3次流產紀錄，請問與下列的何種自體抗體最有相關？
		A.	Anti-dsDNA
		B.	Anti-SSA/Ro
		C.	Anti-Sm
		D.	Anti-histone
		E.	Anti-phospholipid

(C)	4.	41歲的女性來院求診的主訴為手、腳多處關節痠痛有三年之久。最近二個月來發現左手第2、3指的近端指間關節腫脹.在診所抽血檢查發現：ESR 32 mm/h、CRP 1.8 mg/dL、C3 89 mg/dL及C4 17.1 mg/dL，請問下列的何種檢查，對診斷類風濕性關節炎最有幫助？
		A.	Rheumatoid factors
		B.	ANAs
		C.	Anti-CCP antibodies
		D.	Bilateral hand X-ray examination
		E.	Bilateral hand sonographic examination

(E)	5.	48歲女性發現近三年來兩側手指在冬天會變白及變紫，經保暖之後會恢復。最近覺得吞嚥有點困難，及發現雙側手指的皮膚變厚、變硬。請問下列的何種檢查對診斷systemic sclerosis最有幫忙？
		A.	Anti-U1RNP
		B.	Nailfold capillaroscopy
		C.	Pulmonary function test + DLCO
		D.	Anti-centromere antibody
		E.	Anti-topoisomerase-1

(D)	6.	68歲的男性患者在15年前因兩手肘及頭皮皮膚病變，被皮膚科醫師診斷為"乾癬"，經治療之後皮膚症狀穩定。最近一個月來發現兩手多指的遠端指間關節腫脹疼痛。而且有多根手指變成"香腸指樣"(sausage-like finger)。抽血檢查發現ESR 48 mm/1h、CRP 3.8 mg/dL、Rheumatoid factor 14.3 IU/ml (normal < 10 IU/ml)、uric acid 8.1 mg/dL，X-光檢查發現手部遠端指間關節有破壞變型。因另有腰部痠痛經pelvic X-ray檢查發現S-I關節有明顯發炎反應，請問最有可能的診斷為：
		A.	Rheumatoid arthritis
		B.	Gouty arthritis
		C.	Osteoarthritis
		D.	Psoriatic arthropathy
		E.	Ankylosing spondylitis

(B)	7.	下列有關治療風濕病/自體免疫疾病的藥物與其副作用的配對中，在臨床上何者最為嚴重？
		A.	Glucocorticoids--leukocytosis
		B.	Azathioprine--neutropenia
		C.	Methotrexate--oral mucosal ulcer
		D.	Intravenous cyclophosphamide pulse therapy-teratogenicity
		E.	Hydroxychloroquine--retinal detachment

(C)	8.	Rheumatoid arthritis的關節外的臨床表徵很多，下列的何種組合最為正確？(1) keratoconjunctivitis sicca (2) iritis/uveitis (3) periodontitis (4) cerebral vasculitis (5) 頸椎C1-C2 subluxation (6) pleuritis (7) renal tubular acidosis (8) cutaneous vasculitis (9) thrombocytopenia (10) intestinal mucositis
		A.	(1)+(4)+(7)
		B.	(4)+(6)+(7)
		C.	(1)+(5)+(6)
		D.	(3)+(5)+(7)
		E.	(2)+(9)+(10)

(D)	9.	血管炎症候群(vasculitis syndrome)的標幟抗體為ANCA，請問下列那些血管炎是ANCA(+) vasculitis？(1) drug-induced vasculitis (2) granulomatosis with polyangiitis (3) cancer-associated vasculitis (4) Churg-Strauss syndrome (5) Behcet's disease (6) microscopic polyangiitis (7) Kawasaki disease (8) idiopathic crescentic glomerulonephritis (9) giant cell arteritis (10) polyarteritis nodosa
		A.	(1)+(3)+(5)+(7)
		B.	(1)+(2)+(3)+(4)
		C.	(2)+(5)+(6)+(7)
		D.	(2)+(4)+(6)+(8)
		E.	(3)+(8)+(9)+(10)

(B)	10.	Chronic polyarthritis可以包括下列何種疾病？(1) gouty arthritis (2) rheumatoid arthritis (3) pyogenic arthritis (4) calcium pyrophosphate deposition disease (5) osteoarthritis (6) Lyme arthritis (7) pigmented villonodular synovitis (8) reactive arthritis (9) hemophilic hemarthrosis (10) sarcoidosis
		A.	(1)+(2)+(3)
		B.	(2)+(5)+(10)
		C.	(3)+(5)+(9)
		D.	(4)+(6)+(8)
		E.	(5)+(7)+(8)