46 一位60歲男性患者，因胸痛就診後發現有左側肋膜腔積水，抽水檢查發現為exudative effusion, WBC 6200/mm3, neutrophil 20%, lymphocyte 78%，檢測其積水內有高濃度之interferon γ（> 149 pg/mL）。最有可能之診斷為下列何者？

 結核性肋膜腔積水 惡性肋膜腔積水

肺炎性肋膜腔積水 肺栓塞引起之肋膜腔積水

TB!!!!!!!!!!!!!!!!!!!

bakit>

TB

interferon Y

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47 一位70歲男性，因為COPD急性惡化住院，住院1週後原本病情改善，但突然發生急性呼吸喘促與低血壓。動脈血氣體分析結果pH 7.45，PCO2 35 mmHg，PO2 55 mmHg（使用氧氣2 L/min）。V/Q scan判讀為高可能性，雙下肢血管超音波都沒有看到靜脈血栓，此時應該如何處理最為適當？

安排肺動脈攝影 考慮馬上給予血栓溶解劑

安排胸部電腦斷層 進行外科手術

this is case referring to pulmonary embolism

V/Q scan判讀為高可能性: note it is V/Q scan, not V/ Q mismatch!

it is telling you that there is high chance of embolism! high可能性

answer is there give thrombolytics!~

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50 下列藥物中，那一項比較不會引起血糖升高？

Propranolol Glucagon Thiazides Nicotinic acid

answer is A

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濾泡癌 = follicular

51 下列那一項有關甲狀腺分化癌的敘述是正確的？

甲狀腺濾泡癌的發生率比乳突癌多 碘缺乏可能增加甲狀腺濾泡癌的發生

年紀介於20-45歲之間的病人預後不佳 女性病人的預後較差

甲狀腺分化癌Anaplastic cancer

（３）未分化癌(Anaplastic cancer)：佔甲狀腺癌的l0%，通常在50歲以後發生，以女性較多。未分化癌惡性程度高，會迅速侵犯周邊組織，患者有局部淋巴結腫大、疼痛、聲音沙啞、呼吸困難及吞嚥困難等症狀。患者常在診斷確定後數個月內死亡。 不同於乳突癌及濾泡癌者是它不會積聚碘，故無法利用放射性碘（I-131）治療。

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53 Addison’s disease的病人，常見下列那一項變化？

血糖增高 色素缺乏 血鈉增加 嗜伊紅性白血球增加

most common: eosinophilia!!!!!

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55 一位26歲女性，因9個月來次發性無月經、口渴多尿（尿量每天6000毫升）來診，FSH 1.0 mIU/L，LH 1.2 mIU/L，estradiol<20μg/dl，下列那一個診斷最有可能：

下視丘腫瘤 腦垂腺腫瘤 多囊泡卵巢症 長期工作壓力

it is hypothalamic tumor

The regulation of urine production occurs in the hypothalamus, which produces ADH in the supraoptic and paraventricular nuclei. After synthesis, the hormone is transported in neurosecretory granules down the axon of the hypothalamic neuron to the posterior lobe of the pituitary gland where it is stored for later release. In addition, the hypothalamus regulates the sensation of thirst in the ventromedial nucleus by sensing increases in serum osmolarity and relaying this information to the cortex.

The main effector organ for fluid homeostasis is the kidney. ADH acts by increasing water permeability in the collecting ducts and distal convoluted tubule, specifically it acts on proteins called aquaporins which open to allow water into the collecting duct cells. This increase in permeability allows for reabsorption of water into the bloodstream, thus concentrating the urine.