Thursday, November 18, 2010

2 一位17歲女性病患須緊急接受頜下膿瘍(submandibular abscess)引流手術,在進行麻醉前須評估此病患的呼吸道狀況,下列敘述何者錯誤?
麻醉醫師決定適當插氣管內管技術前,須仔細評估病患呼吸道過去病史,並詳細檢查病患之頭頸部
若病患之前有處理呼吸道問題的紀錄,應儘可能調閱並仔細看過
執行全身麻醉直接使用喉頭鏡,做口內氣管內管插管,可能會有無法放置的危險
若病患顎關節活動度受到限制,在給予肌肉鬆弛劑後,顎關節活動度可以達到完全的鬆弛,不會有任何的限制

ANS D

NOTE WITH SUBMANDIBULAR ABSCESS

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6 關於癌症病人之疼痛治療,下列何者正確?
Morphine劑量每日不得超過200 mg以防止呼吸抑制
止痛劑之使用僅限於嚴重疼痛病患(severe pain)
Morphine之最常見副作用為下痢(diarrhea)
止痛劑使用應按時給藥(around the clock)
ANS D

MORPHINE DIARRHEA MDMDMDMDMDMDMDMD

NEVER AROUND THE CLOCK

REMEMBER THE MAGIC BUTTON THAT THE PATIENT CAN PRESS WHENEVER THEY ARE IN PAIN
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10 下列何者不是門診檢查視網膜的主要方法?
間接眼底鏡檢(indirect ophthalmoscopy)
直接眼底鏡檢(direct ophthalmoscopy)
間接細隙燈鏡檢(indirect slit-lamp biomicroscopy)
視網膜鏡檢(retinoscopy)

ANS D
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12 下列何種周邊視網膜變性與視網膜剝離關係最密切?
 囊狀視網膜變性(cystoid degeneration)
格子狀變性(lattice degeneration)
萎縮性視網膜裂孔(atrophic retinal hole)
卵石狀視網膜變性(paving stone degeneration)

ANS B/C

Lattice degeneration is a disease of the eye where peripheral retina becomes atrophic in a lattice pattern and may develop tears / breaks / holes, which may further progress to retinal detachment. It is an important cause of retinal detachment in young myopic individuals. The cause is not known but pathology reveals vascular insufficiency resulting in ischemia and fibrosis.
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13 有關結膜的乳頭狀瘤(papilloma),下列敘述何者正確?
不具有傳染性 極容易轉變為惡性腫瘤
致病機轉與紫外線照射有關 致病機轉與感染human papillomavirus有關

ANS D


In general, papilloma is a histopathological term describing tumors with specific morphology. They take on a classic fingerlike or cauliflowerlike appearance. Papillomatous lesions often are lobulated with a central vascular core. Irrelevant of its cytology, a neoplasm of epithelial origin with this form of growth is also called papilloma. Papillomas can be benign or malignant and can be found in numerous anatomical locations (eg, skin, conjunctiva, cervix, breast duct). Specifically, conjunctival papillomas are benign squamous epithelial tumors with minimal propensity toward malignancy.


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15 下列何者不是風濕性關節炎常見之眼部併發症?
非感染性之角膜潰瘍 結膜淋巴瘤 乾眼症 鞏膜炎

ANS B
結膜淋巴瘤" CONJUNCTIVAL LYMPHOMA


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17 下列有關「急性淚囊炎(acute dacryocystitis)」的敘述,何者錯誤?
可能因鼻淚管阻塞而引起 致病菌大多是細菌
應儘早施行淚囊灌洗術及淚囊探針術 單純使用局部抗生素的效果有限

ANS 應儘早施行淚囊灌洗術及淚囊探針術

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21 有關第二鰓裂瘻管(second branchial fistula)之敘述,下列何者正確?
 此瘻管有一端開口在胸鎖乳突肌之前緣 此瘻管在第九對與十二對顱神經間穿過
此瘻管有一端開口在喉部 此瘻管在內頸動脈後方穿過

ANS A
胸鎖乳突肌 scm


Second branchial cleft cysts

The second branchial cleft accounts for 95% of branchial anomalies, and they are most frequently identified along the anterior border of the upper third of the sternocleidomastoid muscle and adjacent to the muscle. However, these cysts may present anywhere along the course of a second branchial fistula, which proceeds from the skin of the lateral neck, between the internal and external carotid arteries, and into the palatine tonsil (see the following image). Therefore, a second branchial cleft cyst is part of the differential diagnosis of a parapharyngeal mass.

First branchial cleft cysts

First branchial cleft cysts are divided into type I and type II. Type I cysts are located near the external auditory canal. Most commonly, they are inferior and posterior to the tragus (base of the ear), but they may also be in the parotid gland or at the angle of the mandible. Type II cysts are associated with the submandibular gland or found in the anterior triangle of the neck (see the image below).

Third branchial cleft cysts

Third branchial cleft cysts are rare. A third branchial fistula extends from the same skin location as a second branchial fistula (recall that the clefts merge during development); however, a third branchial fistula courses posterior to the carotid arteries and pierces the thyrohyoid membrane to enter the larynx, terminating on the lateral aspect of the pyriform sinus. Third branchial cleft cysts occur anywhere along that course (eg, inside the larynx), but they are characteristically located deep to the sternocleidomastoid muscle (see the image below).

Fourth branchial cleft cysts

Fourth branchial cleft cysts are extremely rare. A fourth branchial fistula arises from the lateral neck and parallels the course of the recurrent laryngeal nerve (around the aorta on the left and around the subclavian artery on the right), terminating in the apex of the pyriform sinus; therefore, fourth branchial cleft cysts arise in various locations, including the thyroid gland and mediastinum.

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