一○八年度內專筆試題

一○八年度內科專科醫師考試筆試題 -- 腫瘤科

(E) 1. 肺腫瘤的治療選項，上皮生長因子接受體(EGFR, epidermal growth factor receptor)的小分子抑制劑藥物是重要的選擇。下列何種病人肺腫瘤有「EGFR突變」的機率最高?

A. A 35-year-old woman with a carcinoid tumor

B. A 25-year-old man with a hamartoma

C. A 75-year-old man with squamous cell carcinoma and a history of asbestos exposure

D. A 58-year-old man with a 100-pack-year history of tobacco use with small-cell lung carcinoma

E. A 54-year-old woman who has never smoked with an adenocarcinoma

(D) 2. 一位58歲女性因腳上有一逐漸長大的黑痣而至皮膚科求診，黑痣最長直徑約9mm，邊緣不規則，病人自己發覺黑痣除了逐漸變大之外，顏色也漸加深變黑。切片檢查證實是黑色素瘤(melanoma)，深度由皮膚表面一直延伸入真皮層(dermis)共深達0.5mm，計算每1mm之有絲分裂(mitosis)<1 (<1 mitosis/mm)。下列因素何者對病人黑色素瘤的預後(prognosis)的影響最大?

A. Anatomic site

B. Sex

C. Number of mitoses

D. Breslow Depth

E. Clark level

(E) 3. 一69歲男性，病理切片診斷確診罹患小細胞肺癌 (SCLC, small-cell lung cancer)，PET/CT掃描結果顯示右側肺門(hilar)部位有一4 x 5公分腫塊，且同側有中等量(moderate)的肋膜積水，經肋膜積水穿刺檢查，肋膜積水細胞學證實同樣有SCLC癌細胞。下列敘述何者為真?

A. Surgical therapy alone has a high curative rate for his stage of SCLC

B. Radiation plays no palliative role at all in therapy for this disease

C. Twenty percent of patients with SCLC are diagnosed with the same stage of disease as this patient

D. The majority of patients with SCLC of this stage respond to chemotherapy alone and go into remission with a very high 3-year survival

E. This patient has extensive-stage disease

(E) 4. 下列危險因子，何者與食道鱗狀上皮細胞癌(squamous cell carcinoma)與食道腺癌(adenocarcinoma)均密切相關?

A. Male sex

B. Chronic gastroesophageal reflux disease

C. Barrett's esophagus

D. Lye ingestion

E. Cigarette smoking

(D) 5. 若針對「原發部位不明上皮癌」(CUP, carcinoma of unknown primary)的腫瘤檢體，進行次世代基因定序分析(NGS, next generation sequencing)，最常見發生基因變異(GA, genetic alterations)的基因為下列何者?

A. KRAS

B. CDKN2A

C. ARID1A

D. TP53

E. MTOR

(E) 6. 一位31歲男性，若有下列理學檢查發現或家族病史，會需要將「遺傳性非多發息肉性大腸癌」 (HNPCC，hereditary nonpolyposis colon cancer) 積極列入篩檢(screening)的考慮?

A. Innumerable polyps visualized on routine colonoscopy

B. Mucocutaneous pigmentation

C. New diagnosis of ulcerative colitis

D. (A)+(B)+(C)

E. Father, paternal uncle, and paternal cousin with colon cancer diagnosed at age 50, 66, and 35 years, respectively

(C) 7. 下列病人情形，何者與罹患頭頸部癌症(head and neck cancers)的風險增加，最無關連?

A. Alcohol consumption

B. Tobacco consumption

C. Helicobacter pylori infection

D. Epstein Barr virus infection

E. Human papillomavirus infection

(D) 8. 下列何者為最常見的惡性淋巴腫瘤 (lymphoid malignancy)?

A. Chronic lymphoid leukemia (CLL)

B. Acute lymphoid leukemia (ALL)

C. Hodgkin lymphoma (HD)

D. Non-Hodgkin lymphoma (NHL)

E. Multiple myeloma (MM)

(C) 9. 48歲女性病人，罹患第四期卵巢癌(ovarian cancer)，接受6個療程carboplatin合併paclitaxel化學治療後，比較電腦斷層掃描前後的差異，如療效評估根據Response Evaluation Criteria in Solid Tumors (RECIST), 第1.1版(Ver. 1.1)的定義，若腫瘤治療後可測量的腫瘤「最長直徑」(longest diameters)的總和，共縮小了15%，且效果持續至少4週。可以評估她的卵巢癌對化學治療的"反應" (response)為何?

A. Complete response (CR)

B. Partial response (PR)

C. Stable disease (SD)

D. Progressive disease (PD)

E. 以上皆非

(C) 10. 有關膽管癌(cholangiocarcinoma)的敘述，下列何者並不正確?

A. The incidence of cholangiocarcinoma has been increasing in recent years

B. Primary sclerosing cholangitis and hepatitis C virus infection are associated with cholangiocarcinoma

C. Most patients present due to an abnormal screening ultrasound, without symptoms

D. Asians infected with liver flukes have an increased risk of cholangiocarcinoma

E. Surgical resection may achieve 40% 5-year Survival with an R0 resection

< 一○八年度試題目錄 >

(E)	1.	肺腫瘤的治療選項，上皮生長因子接受體(EGFR, epidermal growth factor receptor)的小分子抑制劑藥物是重要的選擇。下列何種病人肺腫瘤有「EGFR突變」的機率最高?
		A.	A 35-year-old woman with a carcinoid tumor
		B.	A 25-year-old man with a hamartoma
		C.	A 75-year-old man with squamous cell carcinoma and a history of asbestos exposure
		D.	A 58-year-old man with a 100-pack-year history of tobacco use with small-cell lung carcinoma
		E.	A 54-year-old woman who has never smoked with an adenocarcinoma

(D)	2.	一位58歲女性因腳上有一逐漸長大的黑痣而至皮膚科求診，黑痣最長直徑約9mm，邊緣不規則，病人自己發覺黑痣除了逐漸變大之外，顏色也漸加深變黑。切片檢查證實是黑色素瘤(melanoma)，深度由皮膚表面一直延伸入真皮層(dermis)共深達0.5mm，計算每1mm之有絲分裂(mitosis)<1 (<1 mitosis/mm)。下列因素何者對病人黑色素瘤的預後(prognosis)的影響最大?
		A.	Anatomic site
		B.	Sex
		C.	Number of mitoses
		D.	Breslow Depth
		E.	Clark level

(E)	3.	一69歲男性，病理切片診斷確診罹患小細胞肺癌 (SCLC, small-cell lung cancer)，PET/CT掃描結果顯示右側肺門(hilar)部位有一4 x 5公分腫塊，且同側有中等量(moderate)的肋膜積水，經肋膜積水穿刺檢查，肋膜積水細胞學證實同樣有SCLC癌細胞。下列敘述何者為真?
		A.	Surgical therapy alone has a high curative rate for his stage of SCLC
		B.	Radiation plays no palliative role at all in therapy for this disease
		C.	Twenty percent of patients with SCLC are diagnosed with the same stage of disease as this patient
		D.	The majority of patients with SCLC of this stage respond to chemotherapy alone and go into remission with a very high 3-year survival
		E.	This patient has extensive-stage disease

(E)	4.	下列危險因子，何者與食道鱗狀上皮細胞癌(squamous cell carcinoma)與食道腺癌(adenocarcinoma)均密切相關?
		A.	Male sex
		B.	Chronic gastroesophageal reflux disease
		C.	Barrett's esophagus
		D.	Lye ingestion
		E.	Cigarette smoking

(D)	5.	若針對「原發部位不明上皮癌」(CUP, carcinoma of unknown primary)的腫瘤檢體，進行次世代基因定序分析(NGS, next generation sequencing)，最常見發生基因變異(GA, genetic alterations)的基因為下列何者?
		A.	KRAS
		B.	CDKN2A
		C.	ARID1A
		D.	TP53
		E.	MTOR

(E)	6.	一位31歲男性，若有下列理學檢查發現或家族病史，會需要將「遺傳性非多發息肉性大腸癌」 (HNPCC，hereditary nonpolyposis colon cancer) 積極列入篩檢(screening)的考慮?
		A.	Innumerable polyps visualized on routine colonoscopy
		B.	Mucocutaneous pigmentation
		C.	New diagnosis of ulcerative colitis
		D.	(A)+(B)+(C)
		E.	Father, paternal uncle, and paternal cousin with colon cancer diagnosed at age 50, 66, and 35 years, respectively

(C)	7.	下列病人情形，何者與罹患頭頸部癌症(head and neck cancers)的風險增加，最無關連?
		A.	Alcohol consumption
		B.	Tobacco consumption
		C.	Helicobacter pylori infection
		D.	Epstein Barr virus infection
		E.	Human papillomavirus infection

(D)	8.	下列何者為最常見的惡性淋巴腫瘤 (lymphoid malignancy)?
		A.	Chronic lymphoid leukemia (CLL)
		B.	Acute lymphoid leukemia (ALL)
		C.	Hodgkin lymphoma (HD)
		D.	Non-Hodgkin lymphoma (NHL)
		E.	Multiple myeloma (MM)

(C)	9.	48歲女性病人，罹患第四期卵巢癌(ovarian cancer)，接受6個療程carboplatin合併paclitaxel化學治療後，比較電腦斷層掃描前後的差異，如療效評估根據Response Evaluation Criteria in Solid Tumors (RECIST), 第1.1版(Ver. 1.1)的定義，若腫瘤治療後可測量的腫瘤「最長直徑」(longest diameters)的總和，共縮小了15%，且效果持續至少4週。可以評估她的卵巢癌對化學治療的"反應" (response)為何?
		A.	Complete response (CR)
		B.	Partial response (PR)
		C.	Stable disease (SD)
		D.	Progressive disease (PD)
		E.	以上皆非

(C)	10.	有關膽管癌(cholangiocarcinoma)的敘述，下列何者並不正確?
		A.	The incidence of cholangiocarcinoma has been increasing in recent years
		B.	Primary sclerosing cholangitis and hepatitis C virus infection are associated with cholangiocarcinoma
		C.	Most patients present due to an abnormal screening ultrasound, without symptoms
		D.	Asians infected with liver flukes have an increased risk of cholangiocarcinoma
		E.	Surgical resection may achieve 40% 5-year Survival with an R0 resection