2 開心手術時，當體外循環的支持停止後，血液中的肝素（heparin），必須使用下列何種方式處理，使其活化凝血時間（activated clotting time）回復正常？

血小板靜脈注射 新鮮血漿靜脈注射

魚精蛋白（protamine sulfate）靜脈注射 冷沈澱物（cryoprecipitate）靜脈注射

C

Protamine sulfate is a drug that reverses the anticoagulant effects of heparin by binding to it.

Dosage for heparin reversal is 1mg protamine sulfate i.v. for every 100 IU of active heparin.

HEPARIN ACTIVATES ANTITHROMBIN

==============

3 男性女乳症（gynecomastia）不發生於：

肝硬化病人 睪丸腫瘤（testicular tumor）病人

正常男性 女變男變性者

D

SHE WAS A FEMALE! HELLO! CONFUSING QUESTION. TRICKY THOUGH!

=============

7 一位52歲男性，主訴近2個月來逐漸吞嚥困難，經上消化道內視鏡檢查發現，在其距門齒下23公分處有一腫瘤阻塞了整個食道管徑。經病理切片診斷，證實為食道鱗狀上皮細胞癌。此腫瘤最可能往外侵犯至那一器官？

 氣管 橫膈膜 心包膜 肺靜脈

A

==============

8 有關排便和排氣的anorectal sensory receptor是位在直腸的那一層構造？

黏膜層 黏膜下層 肌肉層 漿膜層

C

============

13 有關皮膚移植片（skin graft）之敘述，下列何者正確？

裂層皮膚移植片（split thickness skin graft）之初期收縮（primary contraction）比全層皮膚移植片（full thickness skin graft）大

全層皮膚移植片之繼發性收縮（secondary contraction）比裂層皮膚移植片大

於屈側（flexor side）行皮膚移植，以全層皮膚移植片為首選

眼皮之植皮，以裂層皮膚移植片為首選

C

=============

14 下列有關葡萄酒斑（port-wine stain）的敘述，何者錯誤？

位於皮膚之血管瘤 位於皮膚之血管畸形 可利用雷射治療 可用手術切除

A

THIS IS NOT HEMANGIOMA

A port-wine stain or naevus flammeus is a vascular birthmark consisting of superficial and deep dilatedcapillaries in the skin which produce a reddish to purplish discolouration of the skin.

=============

15 有關上肢截斷所容許的缺血時間取決於其內含物所能忍受的缺血時間，其中肌肉所能忍受的缺血時間最長是幾個小時？

10小時 8小時 6小時 4小時

6 : SIX : 死

===============

17 下列關於併指症（syndactyly）的敘述，何者錯誤？

 最常發生在第二、三指間（2nd web space）

是最常見的先天性手異常（congenital hand deformity）

有很強的家族性傾向（familial tendency）

男性較多

A

IT IS THE 3RD SPACE!!!!

In simple syndactyly, the third web space between the long finger and the ring finger is the area most commonly involved, followed by the fourth, second, and (rarely) first web spaces. Bilateral involvement is found in 50% of patients.

===================

18 一位糖尿病病患因足部潰瘍，全身發冷發熱來看診，除抗生素治療外，如何處置最為適當？

 立即施行清創手術 待血糖穩定後再施行清創手術

待病患不再發冷發熱後再施行清創手術 待血液細菌培養結果出來後，再施行清創手術

A

==================

20 一位17歲男性，發生頭部外傷和左肘部骨折脫位，經整復肘關節後以石膏固定，2個月後發現肘部腫脹消退，但在肘部前方出現一個硬塊，施行X光檢查發現一塊骨化的團塊，經診斷為myositis ossificans，此時其處理的方式，下列何者正確？

施行積極推拿和伸展，以期改善關節運動範圍 使用固定板保護關節，並施行溫和復健

應在早期施行切除手術 藥物Indocid或輻射治療會加重病況

B

Myositis ossificans comprises two syndromes characterized by heterotopic ossification (calcification) of muscle.

======

30 長期Crohn’s疾病可能導致小腸及大腸惡性病變，以何種惡性腫瘤居多？

 類癌（carcinoid） 淋巴癌（lymphoma）

腺癌（adenocarcinoma） 組織間質癌（stromal tumor）

C

===============

32 一位53歲男性病患，主訴有腹痛。其腹部超音波及電腦斷層掃描顯示主胰臟管均相當擴大及胰臟頭部有囊狀病灶的變化，且病人血清的amylase為720 IU/L，lipase為1,200 IU/L，而其ERCP呈現胰管及ampulla of Vater擴張及有黏液性物質流出。本病人最可能的診斷為：

mucinous cystadenoma serous cystadenoma

intraductal mucin-producing tumor papillary and cystic tumor of the pancreas

C

NOTE: 而其ERCP呈現胰管及ampulla of Vater擴張及有黏液性物質流出

CLUE FOR THE INTRADUCTAL THING!

==================

47 有關solitary rectal ulcer syndrome之敘述，下列何者錯誤？

 一定要有肛門口近端4到12公分處的anterior rectal wall ulcer才算

常發生在長期便祕，需用力解便之年輕女性

影像學診斷常依賴defecography之rectal prolapse、internal prolapse及paradoxical puborectalis syndrome等

病理組織學上與直腸癌或克隆氏症（Crohn’s disease）的鑑別診斷並不難

a

The lesions are located in the anterior rectal wall within 10 cm of the anal verge in the majority of patients

-================

41 一位40歲女性右側乳房有一個4.5公分硬塊，乳房X光攝影結果疑似惡性腫瘤，病人右鎖骨上同時有一個1.5公分大小的淋巴結而細針穿吸細胞學檢查認為是轉移性癌，病人之胸部X光檢查及腹部超音波、骨掃描皆無異常現象。該病人臨床上應屬於第幾期？

IIA IIB IIIA IIIB

bonus

but the answer is likely IIB or IIIB

STAGE IIA and IIB

Tumor less than 2 cm and/or lymph nodes under the arm involved (IIA) OR
Tumor greater than 2 cm but less than 5 cm and lymph nodes involved (IIB) OR
STAGE IIIB and Inoperable IIIC

Tumor of any size with spread to tissues near the breast (skin of the breast or muscles or ribs of the chest wall), and possibly to lymph nodes in the area (IIIB) OR

Tumor of any size with spread to lymph nodes in or near the breast and to lymph nodes in or near the neck and above the collarbone (inoperable IIIC)Tumor greater than 5 cm but no lymph nodes involved (IIB)

STAGE 0

There is no evidence of cancer cells breaking out of the part of the breast in which they started or of getting through to or invading neighboring normal tissue

STAGE I

Tumor less than or equal to 2 cm; no lymph nodes involved

STAGE IIIA and Operable IIIC

Tumor greater than 5 cm with lymph nodes involved (IIIA) OR
Tumor less than 5 cm and lymph nodes under the arm involved and clumped together (IIIA) OR
Any size tumor with spread to more than 10 lymph nodes in or near the breast and/or lymph nodes near the neck or under the collarbone (operable IIIC)

STAGE IV

The cancer has spread to other organs of the body -- most often the bones, lungs, liver, or brain