16 關於C型肝炎的自然病史，下列何者錯誤？
慢性C型肝炎經過20-30年後，約有10-20%的帶原者會發展成肝硬化
肝硬化病例每年有3-5%生成肝細胞癌的危險性
男性酗酒及40歲以後感染是慢性C型肝炎快速進展之危險因子
慢性C型肝炎是我國肝臟移植最主要的適應症

a or D

a is wrong bec it is 10-20 years 10-20 % will have live cirrhosis
d is wrong bec it is HBV not HCV as the most common cause

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17 一位60歲男性因消化性潰瘍出血接受過胃部分切除手術（Billroth II procedure）後發生飯後腹痛、脹氣、腹瀉合併脂肪和維生素B12的吸收不良情形，治療上下列何項藥物最適當？
質子幫浦抑制劑（proton pump inhibitor） 抗生素（antibiotics）
胃腸蠕動促進劑（prokinetics） 制酸劑（antacid）

ans is B: antibiotics

After surgery involving the stomach and duodenum (most commonly with Billroth II antrectomy), a blind loop may be formed, leading to stasis of flow of intestinal contents. This can cause overgrowth, and is termed blind loop syndrome

Billroth II, more formally Billroth's operation II, is an operation in which the lower part of the stomach (antrum) is removed and a loop of small bowel(jejunum) is brought up and joined to it in a (side-to-side manner) for drainage (gastrojejunostomy)

Billroth I, more formally Billroth's operation I, is an operation in which the pylorus is removed and the distal stomach is anastomosed directly to theduodenum.

Gastric bypass, Roux en-Y (proximal)

This variant is the most commonly employed gastric bypass technique, and is by far the most commonly performed bariatric procedure in the United States. It is the operation which is least likely to result in nutritional difficulties. The small bowel is divided about 45 cm (18 in) below the lower stomach outlet, and is re-arranged into a Y-configuration, to enable outflow of food from the small upper stomach pouch, via a "Roux limb". In the proximal version, the Y-intersection is formed near the upper (proximal) end of the small bowel. The Roux limb is constructed with a length of 80 to 150 cm (31 to 59 in), preserving most of the small bowel for absorption of nutrients. The patient experiences very rapid onset of a sense of stomach-fullness, followed by a feeling of growing satiety, or "indifference" to food, shortly after the start of a meal.

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18 一位30歲男性主訴長期有胸痛、食物逆流及吞嚥困難現象，食道攝影檢查如圖，且上消化道內視鏡檢查顯示食道黏膜正常，其最佳治療方式為何？

Proton pump inhibitor

Calcium channel blocker

Laparoscopic fundoplication

Laparoscopic myotomy

answer D

fundoplication is for GERD

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一位73歲男性病人因腹瀉2個月並體重減少10公斤而由門診住院。門診超音波檢查顯示有多個肝腫瘤。大腸鏡檢查發現上行結腸有突起之腫瘤，病理檢查證實為腺癌。病人之B型肝炎、C型肝炎標記陰性，胎兒蛋白正常，但癌胚胎抗原（CEA）為1160 ng/mL。病人腹部電腦斷層如附圖。下列何者為此病人之最適合之Dukes分期？

B

C

D

E

this question is asking for colon cancer with mets to the liver!!!!! dont get confused!

the duke applies to the colorectal cancer

ans : DUKE D

大腸鏡檢查發現上行結腸有突起之 腫瘤，病理檢查證實為腺癌

Dukes A: Invasion into but not through the bowel wall
Dukes B: Invasion through the bowel wall but not involving lymph nodes
Dukes C: Involvement of lymph nodes
Dukes D: Widespread metastases