51 在正常情況下每天約有9公升的水會經過小腸，大約有百分之幾的水分會被小腸吸收？

50 60 70 80

ANS 80

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52 2歲大的王小妹妹半夜被抱進急診室，時而哭鬧，不哭時又覺精神倦怠。耳溫槍量到的體溫是40.2℃。媽媽說她下午才開始不舒服，一開始發燒就很燙，給她用肛門塞劑退燒，沒幾個鐘頭又燒了起來，燒到這次已經是第3次了。上述的症狀比較少見於下列那一疾病？

泌尿道感染中耳積液（middle ear effusion）

急性中耳炎急性化膿性扁桃腺炎

ANS

中耳積液（middle ear effusion）

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56 一位60歲男性肺動脈高壓患者在接受肺動脈導管偵測，在氣球打氣膨脹後，病患突然出現大量咳血現象，此時最恰當之立即處置為何？

立刻輸入O型Rh陰性之紅血球濃縮原液（packed RBC）

立刻送往開刀房，做手術修補

注射鎮靜劑以鎮定病人的躁動情緒

氣管內管插管

ANS D

REMEMBER YOUR ABC

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58 一位57歲的尿毒症病患，5年來持續接受血液透析治療，直到2個月前接受了腎臟移植手術。最近他開始出現皮膚搔癢、腹痛、骨頭酸痛等現象，抽血檢查鈣值為12 mg/dL。下列何者是此患者最可能的診斷？

Primary hyperparathyroidism Secondary hyperparathyroidism

Tertiary hyperparathyroidism Parathyroid carcinoma

ANS Tertiary hyperparathyroidism

Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone (PTH) after a long period of secondary hyperparathyroidism and resultinghypercalcemia. It reflects development of autonomous (unregulated) parathyroid function following a period of persistent parathyroid stimulation.

The basis of treatment is still prevention in chronic renal failure, starting medication and dietary restrictions long before dialysis treatment is initiated. Cinacalcet has greatly reduced the number of patients who ultimately require surgery for secondary hyperparathyroidism; however, approximately 5% of patients do not respond to medical therapy.

When secondary hyperparathyroidism is no longer responsive to treatment by medication, it is called tertiary hyperparathyroidism. The treatment of choice is surgical removal of three and one half parathyroid glands.

Secondary hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low bloodcalcium levels) and associated hypertrophy of the glands. This disorder is especially seen in patients with chronic renal failure.

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59 承上題，患者接受副甲狀腺切除手術。下列術前抽血檢查項目中，何者最能預測術後併發低血鈣血症？

鈣離子（calcium ion）濃度磷酸根離子（phosphate ion）濃度

鎂離子（magnesium ion）濃度鹼性磷酸酶（alkaline phosphatase, ALP）濃度

How is it used?

The alkaline phosphatase test (ALP) is used to help detect liver disease or bone disorders. In conditions affecting the liver, damaged liver cells release increased amounts of ALP into the blood. This test is often used to detect blocked bile ducts because ALP is especially high in the edges of cells that join to form bile ducts. If one or more of them are obstructed, for example by a tumor, then blood levels of ALP will often be high.

Any condition that affects bone growth or causes increased activity of bone cells can affect ALP levels in the blood. An ALP test may be used, for example, to detect cancers that have spread to the bone or to help diagnose Paget's disease. This test may also sometimes be used to monitor treatment of Paget's disease or other bone conditions, such as vitamin D deficiency.

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