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(E) 1. ¯f¤H67·³¤k©Ê¡A¦í¦w¾i¦Ñ¤H°|¡A¤U§É¶^¶Ë¥k¸}¡A¤­¤Ñ«á¦]·NÃѤ£²M¦ñ¦³®ð«P¡Bµo¿N¡B´HŸ(chills)¦Ó¦í°|¡C¯f¤H¦³Ãþ­·Àã©ÊÃö¸`ª¢¡A¤]¦³°ª¦åÀ£¦X¨Ö¤ßŦ°IºÜªº¯f¥v¡C¦í°|®É¡AGCS E2V2M3¡FBP¡A112/57 mmHg¡FHR¡A85/min¡Aregular¡FRR¡A25/min¡FÅé·Å¡AÄá¤ó37«×¡F¤ßŦ§e²{³W«ß¡A¦ý¦b¤ß¦y³¡¦³Gr.III/VI Systolic murmur¡F¦bªÍ°ò³B¿BÀã©I§lÁn¡F¥|ªÏ¦h³B·ï¦å¡A¦¹¥~©|µL²§±`©Ò¨£¡C¹êÅç«Ç©Ò¨£¡G¥Õ¦å²y¡A15350/£gL¡FC-¤ÏÀ³³J 44.20 mg/dl(¥¿±`<1.9)¡F¦Ù»ÄÓþ 0.98mg/dl¡F¦í°|²Ä¤G¤Ñ¦³¨â®M¦å²G²Óµß°ö¾i§e²{­²Äõ¶§©Ê¯fµß¡CÁ{§É¶EÂ_¬°·P¬V©Ê¤ß¤º½¤ª¢(infective endocarditis)«á¡A½Ð°Ý¦b¦¹¨è¡A¤U¦C¦óºØ³B¸m¬°©y¡H
A.¶i¦æ¤¶¤J©Ê¤ß¾ÉºÞÀˬd
B.¥~¬ì¤â³N¥HÀò±o²Õ´¶EÂ_
C.¨Ï¥Î IV dopamine 0.5 £ggkg/min ª`®g¡A¥H¼W¥[§¿¶q
D.§@24¤p®É¤ß¹q¹ÏÀˬd¥H½T©w¤ß«ß¤£¾ã
E.§@¶W­µªi¤ß¹ÏÀˬd¥H½T©w¤ßŦ¯fÅÜ
 
(D) 2. ²Óµß©ÊªÍª¢¦X¨Ö¦Ø½¤¿n²G¡A¤U¦C¦óºØ¦Ø½¤¿n²G¤§¼Æ¾Úªí¥Ü¶·´¡¯ÝºÞ¤Þ¬y¡H
A.PMN > 90%
B.WBC > 1000/mm3
C.Glucose < 100 mg/dL
D.pH < 7.2
E.LDH > 300 IU/L
 
(E) 3. ¤U¦C¦³Ãöpancreatic neuroendocrine tumor¤§±Ô­z¡A¦óªÌ¥¿½T¡H (1)glucagonoma¥i¯à¾É­P¿}§¿¯f (2)VIPoma (VIP: vasoactive intestinal peptide)¥i¯à¾É­Ppeptic ulcers (3)insulinoma±`¬°´c©Ê¸~½F (4)EUS (endoscopic ultrasound)¬O°»´ú³oÃþ¸~½F¤§³Ì¨Î¤u¨ã (5) liver metastasis¹ï±wªÌ¤§¹w«á¼vÅT¬Æ¤j
A.(1)+(2)+(3)
B.(2)+(3)+(4)
C.(3)+(4)+(5)
D.(2)+(3)+(5)
E.(1)+(4)+(5)
 
(B) 4. ¤@¦ì24·³¤k©Ê¡A¹L¥hµL¯f¥v¡C¬ù2­Ó¤ë«e¶}©lª`·N¥X²{¤ô¸~¡AÅé­«¦b2­Ó¤ë¤º¼W¥[8¤½¤ç¡C¹êÅç«ÇÀˬd: albumin 2.8 g/dL, creatinine 0.8 mg/dL, t-Chol 280 mg/dL, LDL 163 mg/dL, urine protein-creatinine (P/C) ratio ¬ù9 mg/mg, urinalysis O.B. (-), serum [K] 4 mEq/L, [Ca] 9.2 mg/dL, Hb 12 g/dL¡C¥»¯f¤Hªº¶EÂ_¡A³Ì¥i¯à¬°?
A.IgA nephropathy
B.minimal change disease
C.multiple myeloma with nephropathy
D.systemic lupus erythromatous (SLE) with nephropathy
E.membranoproliferative glomerulonephritis (MPGN)
 
(E) 5. ¦³Ãö¬y·P¬Ì­]±µºØ°Æ§@¥Î»P¸T§Ò¯g¤§±Ô­z¡A¤U¦C¦óªÌ¥¿½T¡H (1)¹ïÂû³JÄY­«¹L±ÓªÌ¬°±µºØ¬y·P¬Ì­]¤§¸T§Ò¡C (2)°£¤F¬ü°ê1976¦~H1N1½Þ¬y·P¬Ì­]¥~¡A±µºØ©u¸`¬y·P¬Ì­]«áµo¥ÍGuillain-Barre syndrome¤§¾÷²v·¥§C¡C (3)¤p©ó6­Ó¤ë¤§À¦¨à¤£©y±µ¨ü¬y·P¬Ì­]¬I¥´¡C (4)³¡¤À¬y·P¬Ì­]¤¤§t¦³¥Ò°ò¨E»P¤A°ò¨E¥Î¥H«O¦s¬Ì­]¡A¥Ò°ò¨E»P¤A°ò¨E§¡¥i¬°¤HÅé©Ò¥NÁ¡C (5)¦b§PÂ_¬y·P¬Ì­]±µºØ«á¤£¨}¨Æ¥ó»P¬Ì­]±µºØ¤§¦]ªGÃö«Y®É¡A¸Ó¤£¨}¨Æ¥ó¤§¦º¤`©Î­«¯g¤ñ²v¬O­«­nªºÆ[¹î«ü¼Ð¡C
A.(1)+(2)+(3)
B.(1)+(2)+(4)
C.(1)+(3)+(4)
D.(1)+(3)+(5)
E.(1)+(2)+(3)+(5)
 
(D) 6. 45·³¤k©Ê¦]­Â«å¡BµL¤O¡B«K¯µ¡BÅé­«¼W¥[¨Ó¶E¡A¨­ÅéÀˬdµo²{¨­°ª160¤½¤À¡BÅé­«60¤½¤ç¡BÁy³¡²¤¬°¯B¸~¡B»a¥Õ¡A¦åÀ£ 146/92 mmHg¡BPR 58/min¡A regular ©â¦åÀˬdµo²{¶º«e¦å¿}100 mg/dl¡BÁx©T¾J 260 mg/dl¡B§C±K«×Áx©T¾J 160 mg/dl¡ANa 128 mM¡BK 4.0 mM¡BCK 1500 U/L¡A¤U¦C³B¸m¦óªÌ³Ì«ê·í¡J
A.µ¹¤©statinªvÀø
B.µ¹¤©angiotensin receptor blocker
C.´úUrine sodium¡Bprotein
D.´ú¦å¤¤ free T4¡BhsTSH
E.´ú¦å¤¤ ACTH¡Bcortisol
 
(D) 7. ¤U¦C¨º¤@¶µ«D¶EÂ_²Ä1«¬¿}§¿¯fªº¥²­n±ø¥ó¡J
A.ªÅ¸¡¦å²MC-Ð`úT¿@«× < 0.5 ng/ml
B.¤É¿}¯À¨ë¿E«á6¤ÀÄÁ¦å²MC-Ð`úT¿@«× < 1.8 ng/ml
C.¤É¿}¯À¨ë¿E¸ÕÅç6¤À»P0¤À¦å²MC-Ð`úT¿@«×¬Û®t < 0.7 ng/ml
D.¿}§¿¯f଻Ĥ¤¬r
E.Anti-GAD65 ¶§©Ê
 
(A) 8. 50·³¤§¨k¯f¤H,¿©±wµh­·¥Û©ÊÃö¸`ª¢(tophaceous gout)¤w1¦~¦h,¨â¤UªÏ¦³³\¦h¤j¤p¤£¤@ªºµh­·¥Û(tophi);¦P®É¦³ºC©ÊµÇ¥\¯à¤£¥þ,¦å¤¤creatinine­È¬°2.5 mg/ml,¨Ã¦³µÇµ²¥Û.¨äHLA-B5801°ò¦]¬°¶§©Ê.½Ð°Ý³Ì¦X¾Aªº­°§¿»ÄÃĪ«¬°¦ó?
A.febuxostat
B.probenecid
C.benzbramarone
D.sulfinpyrazone
E.allopurinol
 
(A) 9. ¤@¦ì27·³ªº¨k©Ê¡A±q¤p´N¦³¤¤µ¥«×«ùÄò«¬ªº¹L±Ó©Ê»óª¢(Allergic rhinitis)¡A¨ä¦å¤¤total IgE 325IU/ml¡A¹L±Ó­ìÀˬdµo²{¹ïhouse dust mite Der.P §e+++¡C½Ð°Ý°£¤Fimmunotherapy¤§¥~¡A¤U¦C¦óªÌ¬°­º¿ïÃĪ«?
A.intranasal glucocorticoids spray
B.moderate dose of oral prednisolone
C.anti-IgE antibody injection
D.oral pseudoephedrine
E.oral H1 antihistamine
 
(A) 10. ¤@¦ì50·³¤k©Ê³Q¶EÂ_¦³portal vein thrombosis¡C©PÃä¦å²GÀˬdµo²{¦³JAK2°ò¦]¬ðÅÜ¡A¦¹¯f¤H³Ì¥i¯à¦³¤U¦C¦óºØ¯e¯f¡H
A.myeloproliferative neoplasm
B.paroxysmal nocturnal hemoglobinuria
C.protein S deficiency
D.protein C deficiency
E.antithrombin III deficiency
 
(C) 11. ¸~½F¼Ð°O(tumor markers)ªºÀ³¥Î¡A¥i¹B¥Î¦b´c©Ê¸~½FªºªvÀø´Á¶¡¡A§@¬°ªvÀø¦¨®Äªº»²§Uµû¦ô¡C¥H¤U¦UºØ¸~½F¼Ð°O»P¸~½Fªº°t¹ï¡A­þ¨Ç¬O¥¿½Tªº? (1)catecholamines»Ppheochromocytoma (2)calcitonin»Ppapillary cancer of the thyroid (3)human chorionic gonadotropin (hCG)»Pgestational trophoblastic disease (4)£\-fetoprotein»Pgonadal germ cell tumor
A.(1)+(2)+(3)
B.(1)+(2)+(4)
C.(1)+(3)+(4)
D.(2)+(3)+(4)
E.(1)+(2)+(3)+(4)
 
(C) 12. ¹ï©óÃhºÃ¦³intestinal obstruction¤§±wªÌ¡A¸¡³¡¢æ¥ú·Ó¬Û¡]plain abdomen¡^¥i´£¨Ñ¬Û·í¦³¥Îªº¸ê®Æ¡C¤U¦C¦U¶µ±Ô­z¡A¦óªÌ¿ù»~¡H
A.plain abdomen¥Î¨Ó§PÂ_nonstrangulating complete small-bowel obstruction¬Û·í¥i¾a
B.partial mechanical small-bowel obstruction»Padynamic ileus¤£¤Ó®e©ö°Ï¤À¡A¦ýcolonic distension¦badynamic ileus³q±`¸û©úÅã
C.µÈ¤jªº¤p¸z¤¤¥i¨£air-fluid levels¡A±`±Æ¦C¦¨¡§stepladder¡¨ pattern¡A¤Ö¨£¤º§tªÅ®ðªº¤j¸z¡A³o¨Çµo²{±`¨£©óstrangulating small-bowel obstruction
D.­YÁ{§É¯gª¬«Ü¹³small intestine obstruction¡A¦ýplain abdomen¬Ý°_¨Ó¥¿±`¡A¦¹®É¦w±Æ¸¡³¡CTÀˬd¦³§U©ó¶EÂ_
E.³Ü¾X¾¯¨ÓÀ°¦£§PÂ_¤p¸zªºªý¶ë³¡¦ì¬O¬Û·í¦w¥þªº
 


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