九十七年度內科專科醫師考試筆試題 – 考古 by 意旋

7 肺外結核（Extra pulmonary tuberculosis）最常發生的部位為：

A. Pleura
B. Bones and joints
C. Lymph nodes
D. Meninges
E. Genitourinary tract

※ C

In order of frequency, the extrapulmonary sites most commonly involved in tuberculosis are the lymph nodes, pleura,
genitourinary tract, bones and joints, meninges, peritoneum, and pericardium . However, virtually all organ systems
may be affected. As a result of hematogenous dissemination in HIV-infected individuals, extrapulmonary tuberculosis is
seen more commonly today than in the past.

Reference: Harrison 17th

8 病人 48 歲，男性，時有頭昏脹疼之苦，在社區診所其左右雙手血壓分別為 124/68 及 172/84 mmHg，左上下

肢血壓為 120/70 及 114/50 mmHg， 病人主動脈呈現雙葉狀(Bicuspid)，心臟理學檢查有左心室肥大，S1 強力，
並在後背部有心縮強出狀 (ejectile)心雜音。
A. 主動脈瓣狹窄 (Aortic stenosis)
B. 大動脈窄縮 (Coarctation of the aorta)
C. 肺動脈瓣狹窄 (Pulmonic stenosis)
D. 心室中隔缺損 (Ventricular septal defect)
E. 開暢性動脈管 (Patent ductus arteriosus)

※ 請參考 95 年 CV #3 B
Coarctation of the Aorta
→ most common：distal to the origin of the left subclavian artery near the insertion of the
ligamentum arteriosum
→ occurs in ~7% of patients with congenital heart disease
→ more common in males than females
→ particularly frequent in patients with gonadal dysgenesis (e.g., Turner syndrome)
※ Clinical manifestations
→ depend on the site and extent of obstruction and the presence of associated cardiac anomalies
→ Circle of Willis aneurysms may occur in up to 10% and pose a high risk of sudden rupture and death
→ Most children and young adults with isolated, discrete coarctation are asymptomatic
 → may occur：Headache、epistaxis、cold extremities、claudication with exercise
※ Associated cardiac anomalies：most commonly a bicuspid aortic valve

9 下列有關社區肺炎(community-acquired pneumonia)住院的條件，何者不正確
A. 呼吸次數 >28/min
B. 中至大量肋膜積水
C. 心舒壓<90 mmHg 或低於正常值 30 mmHg 以上
D. 低血氧(hypoxemia): 室溫下 PaO2 < 60 mmHg，血氧飽和度 < 90%
E. 血糖控制不良

※ C
 Reference : Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired
pneumonia. Ann Intern Med 2003;138:115.

1 關於 IBS( Irritable Bowel Syndvome)之敘述，下列何者是錯誤的？

0 A. IBS 病人很少有 malnutritioin 之情況
B. IBS 病人常因腹部不適而影響其睡眠
C. IBS 病人之腹痛常在進食後、或有情緒困擾時加劇
D. IBS 病人腹瀉時，其大便量通常不多
E. 輕度至中度 IBS 病人較少有 psychosocial 問題
※ B

IBS is a disorder that affects all ages, although most patients have their first symptoms before age 45. Older individuals
have a lower reporting frequency. Women are diagnosed with IBS two to three times as often as men and make up 80% of
the population with severe IBS. Pain or abdominal discomfort is a key symptom for the diagnosis of IBS. These
symptoms should be improved with defecation and/or have their onset associated with a change in frequency or form
of stool. Painless diarrhea or constipation does not fulfill the diagnostic criteria to be classified as IBS. Supportive
symptoms that are not part of the diagn It is frequently episodic and crampy, but it may be superimposed on a background
of constant ache. Pain may be mild enough to be ignored or it may interfere with daily activities. Despite this,
malnutrition due to inadequate caloric intake is exceedingly rare with IBS . Sleep deprivation is also unusual
because abdominal pain is almost uniformly present only during waking hours. However, patients with severe IBS
frequently wake repeatedly during the night; thus, nocturnal pain is a poor discriminating factor between organic and
functional bowel disease. ostic criteria include defecation straining, urgency or a feeling of incomplete bowel movement,
passing mucus, and bloating. A smaller portion have moderate symptoms that are usually intermittent and
correlate with altered gut physiology, e.g., worsened with eating or stress and relieved by defecation.

In other patients, diarrhea may be the predominant symptom. Diarrhea resulting from IBS usually consists of small
volumes of loose stools. Most patients have stool volumes of < 200 mL. Nocturnal diarrhea does not occur in IBS.
Diarrhea may be aggravated by emotional stress or eating.
1 有一 50 歲男性，在門診發現血中肌酸酐（creatinine）為 1.4 mg/dl，血鉀（potassium）為 6.2 mEq/L，病人無
1 症狀，亦未服用葯物，你應如何處理？
A. 立刻注射 Calcium gluconate。
B. 儘快做個心電圖，同時重抽血鉀。
C. 給予葡萄糖加 insulin 靜脈注射。
D. 靜脈注射 NaHCO3。
E. 給予 Kayexalate。

※ Pseudohyperkalemia represents an artificially elevated plasma K+ concentration due to K+ movement out of B

cells immediately prior to or following venipuncture. Contributing factors include prolonged use of a tourniquet
with or without repeated fist clenching, hemolysis, and marked leukocytosis or thrombocytosis.
 Reference : Harrison

1 一名 60 歲停經婦女，過去未有全身性疾病，也未接受過手術治療，兩年前體檢 CBC 正常，最近半年逐漸出

2 現臉色蒼白及運動後呼吸急促現象，但無其他不適，其 CBC 如下：Hb 7.2 gm/dL，MCV 70.Fl，白血球
3,950/uL，分類正常，血小板 375,000 /uL，下列何項檢查對診斷最有幫助
A. 小便檢查
B. 大便檢查
C. 肝功能檢查
D. 腎功能檢查
E. 骨髓檢查

從題目可知是 microcytic anemia,沒有 thalassemia history ，最有可能的是 IDA.IDA 可能原因如下表,要先排除 B

acute blood loss,故答案為大便檢查

Reference: Harrison 17th edition