73 一位57歲男性鼻咽癌末期病人，因呼吸困難、疼痛及進食困難，而入住安寧病房，有關癌症末期病人的營養（nutrition）問題，下列敘述何者錯誤？
末期病人因進食困難而吃的少是家屬常關心之問題
接受插入鼻胃管灌食之末期病人，會有自拔鼻胃管及造成吸入性肺炎的機會
目前並沒有證據顯示強迫進食可以延長末期病人生命
對於吃的少的末期病人，應該積極強調全靜脈營養補充（total parenteral nutrition）的重要性

ANS D

NOTE: THIS IS HOSPICE CARE


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75 一位62歲男性肝癌患者入急診求醫，主訴為8小時前開始發燒發冷（fever and chills）。病人1天前才做完腫瘤栓塞（transcatheter arterial embolization）出院。體溫為38.9℃。理學檢查發現腹部脹大，有瀰漫性壓痛（diffuse tenderness），並伴隨有輕微反彈痛（rebounding tenderness）。針對此病人的臨床表現，下列敘述何者最為適當？
病人須同時符合有發燒、腹部壓痛以及意識變差三種症狀，才能懷疑有自發性細菌腹膜炎（spontaneous bacterial peritonitis）
若腹水檢查發現多形核嗜中性白血球（polymorphic neutrophil）超過250/mL，可診斷病人有自發性細菌腹膜炎
此病人剛做完腫瘤栓塞，可推斷發燒現象必是由腫瘤壞疽（tumor necrosis）所造成
若懷疑病人有自發性細菌腹膜炎，首選藥物為第一代頭孢菌素類抗生素（cephalosporin）加上aminoglycoside

ANS B

Diagnosis

Diagnosis necessitates paracentesis (needle drainage of the ascitic fluid) and laboratory confirmation of ascitic neutrophils > 250/mm³.[1]
[edit]Treatment

[edit]Antibiotics
After confirmation of SBP, patients need hospital admission for intravenous antibiotics (most often cefotaxime 2g IV Q8-12H for at least 5 days or ceftriaxone 2g IV Q24H). They will often also receive intravenous albumin. A repeat paracentesis in 48 hours is sometimes performed to ensure control of infection. Once patients have recovered from SBP, they require regular prophylactic antibiotics (e.g. Septra DS 1 tab 5 times/week, Ciprofloxacin 750 mg PO Q1W, norfloxacin 400 mg Q24H) as long as they still have ascites.