This is a different kind of arteriosclerosis. This is hyperplastic arteriolosclerosis, which most often appears in the kidney in patients with malignant hypertension. The arteriolar wall is markedly thickened and the lumen is narrowed.

Arteriosclerosis, or "hardening of the arteries" is a generic term that includes atherosclerosis, arteriolosclerosis, and medial calcific sclerosis.

http://library.med.utah.edu/WebPath/ATHHTML/ATH022.html

99 14 歲女孩出現惡性高血壓（200/130 mmHg），腹部影像學檢查顯示一腎上腺腫瘤，尿中兒茶酚

胺（catecholamine）以及血清腎素（serum renin）均升高。下列腎臟血管變化中，何者與此腫瘤有最

密切的關係？

 Hyaline arteriolosclerosis  Hyperplastic arteriolosclerosis

 Atherosclerosis  Thromboembolism

50 硬脂酸（stearic acid）完全氧化，須經過beta-oxidation 途徑幾次？

 6  7  8  9

8

STEARATE: 8 LETTERS!

34 細胞中各種基因的表達常因不同組織而有差異。在一些基因的啟動子（promoter）上常有一些CpG

島（CpG island）。同一基因的表達，常因CpG 島受到下列何種修飾（modification）而有不同？

 乙烯化（acetylation）  甲基化（methylation）

 磷酸化（phosphorylation）  羧化（carboxylation）

M-ethylation

M-odification

18 張先生因為心悸被送到急診室，心電圖檢查發現有上心室心搏過速（supraventricular tachycardia），

在旁之醫師馬上做頸動脈竇按摩以減輕其症狀，其主要作用機轉為何？

 抑制Brainbridge 反射 活化減壓反射（baroreflex）

 活化化學反射（chemoreflex）  抑制迷走中樞（vagal center）

ans baroreflex

The carotid sinus contains numerous baroreceptors, which function as a "sampling area" for many homeostatic mechanisms for maintaining blood pressure.

can not be inhibit the vagal center: if you inhibit it, result in tachycardia

13 下列關於唾液（saliva）之敘述，何者正確？

 通常呈現酸性 為一種高張（hypertonic）液體

 內含鉀離子（K+）濃度比血漿內高 內含鈉離子（Na+）濃度比血漿內高

ans 通常呈現酸性 and內含鉀離子（K+）濃度比血漿內

Electrolytes:

• 2-21 mmol/L sodium (lower than blood plasma)
• 10-36 mmol/L potassium (higher than plasma)
• 1.2-2.8 mmol/L calcium (similar to plasma)
• 0.08-0.5 mmol/L magnesium
• 5-40 mmol/L chloride (lower than plasma)
• 25 mmol/L bicarbonate (higher than plasma)
• 1.4-39 mmol/L phosphate
• Iodine (mmol/L usually higher than plasma, but dependent variable according to dietary iodine intake)

12 將胃內迷走神經傳入纖維（vagal afferent fibers）阻斷時，下列敘述何者正確？

 增加因組織胺（histamine）所刺激的胃酸分泌

 降低體抑素（somatostatin）的分泌

 降低因胃壁擴張（distension）所引起的胃酸分泌

 降低因胃內蛋白質食物刺激所引起的胃泌素（gastrin）分泌

ans c

remember vagotomy

the gastric acid secretion is caused by distention via vagal pathway

6 比較第一型和第二型骨骼肌纖維時，下列何者錯誤？

 第一型纖維的粒線體含量較豐富 第一型纖維較易疲乏

 第一型纖維的肌球蛋白含量較豐富 第一型纖維的微血管含量較豐富

ans 第一型纖維較易疲乏

Type I fibers	Type II a fibers	Type II x fibers	Type II b fibers
Contraction time	Slow	Moderately Fast	Fast	Very fast
Size of motor neuron	Small	Medium	Large	Very large
Resistance to fatigue	High	Fairly high	Intermediate	Low
Activity Used for	Aerobic	Long-term anaerobic	Short-term anaerobic	Short-term anaerobic
Maximum duration of use	Hours	<30 minutes	<5 minutes	<1 minute
Power produced	Low	Medium	High	Very high
Mitochondrial density	High	High	Medium	Low
Capillary density	High	Intermediate	Low	Low
Oxidative capacity	High	High	Intermediate	Low
Glycolytic capacity	Low	High	High	High
Major storage fuel	Triglycerides	Creatine phosphate, glycogen	Creatine phosphate, glycogen	Creatine phosphate, glycogen
Myosin heavy chain, human genes	MYH7	MYH2	MYH1	MYH4

ciliary muscle contraction: parasympathetic movement

94 職業引起的帕金森氏症（Parkinsonism）與以下何種物質之暴露最有關？

 汞（Mercury）  錳（Manganese）

 四氯化碳（Carbon tetrachloride）  有機磷劑（Organophosphate）

ANS MANGANESE!!!

MAN- OLD MAN PARKINSON FREQUENT!

The coefficient of variation (CV) is defined as the ratio of the standard deviation to the mean :

84 某班護理系學生50 名參加內外科護理及精神科護理兩科測驗，其中內外科護理的全班平均分數為78

分、標準差為8 分，精神科護理的全班平均分數為70 分、標準差為8 分。該兩科目測驗分數之變異

係數值（coefficient of variation）為：

 內外科護理＝精神科護理 內外科護理＞精神科護理

 內外科護理＜精神科護理 資訊不足無法判定

ANS C

8/78 VS 8/70

Epidermophyton is a genus of fungus causing superficial and cutaneous mycoses, includingE. floccosum, a cause of tinea corporis (ringworm), tinea cruris (jock itch), tinea pedis(athlete’s foot), and onychomycosis or tinea unguium, a fungal infection of the nail bed.

61 表皮癬菌屬（Epidermophyton）可引起：

 鵝口瘡 頭癬 甲癬 汗斑

B/C

57 下列節肢動物媒介病毒（Arbovirus）中，那一種病毒不以節肢動物為傳播之媒介？

 黃熱病病毒（Yellow fever virus）  西尼羅河腦炎病毒（West Nile virus）

 拉薩病毒（Lassa virus）  登革病毒（Dengue virus）

ANS LASSA

LASSA RATS!

DIRTY RATS! AS VECTOR!

LASSA FEVER: ACURE HEMORRHAGIC FEVER! BY LASSA VIRUS

Herpangina, also called mouth blisters, is the name of a painful mouth infection caused bycoxsackieviruses. Usually, herpangina is produced by one particular strain of coxsackie virus A (and the term "herpangina virus" refers to coxsackievirus A)^[1] but it can also be caused by coxsackievirus B or echoviruses.^[2] Most cases of herpangina occur in the summer,^[3]affecting mostly children. However, it occasionally occurs in adolescents and adults. It was first characterized in 1920

53 下列關於病毒與其可引起之疾病的敘述，何者錯誤？

 呼吸道融合病毒（Respiratory syncytial virus）可引起肺炎（pneumonia）

 副流行性感冒病毒（Parainfluenza virus）可引起哮喘（croup）

 鼻病毒（Rhinovirus）可引起疱疹性咽呷炎（herpangina）

 冠狀病毒（Human coronavirus）可引起感冒（common cold）

ANS C

The Bile Solubility Test

Bile will selectively lyse colonies of Streptococcus pneumoniae while other strep are immune to bile's activity. When a bile salt such as desoxycholate is added directly to Streptococcus pneumoniae growing on an agar plate or in a broth culture the bacteria will lyse and the area become clear. Other alpha-hemolytic streptococci are resistant to (not lysed by) bile and will stay visible or turbid (cloudy).

48 肺炎鏈球菌（Streptococcus pneumoniae）可用下列何種方法鑑定？

 尿素酶試驗（urease test）  膽汁溶解試驗（bile solubility test）

 錫克氏試驗（Schick test）  氧化酶試驗（oxidase test）

45 DNA 病毒之蛋白質可與調節細胞週期之p53 蛋白質作用者為：

 人類乳頭瘤病毒第十六型（HPV16）之E6 蛋白質

 人類乳頭瘤病毒第十六型（HPV16）之E7 蛋白質

 腺病毒（Adenovirus）之E1A 蛋白質

 EB 病毒（Epstein-Barr virus）潛伏性膜蛋白質第一型（LMP1）

ans a

The E6/E7 proteins inactivate two tumor suppressor proteins, p53 (inactivated by E6) and pRb (inactivated by E7).

E6 = P53 (((((6-5-3)

E7 = Rb GENE (((((((7-RB) SOUND LIKE CRV

29 下列何者不是由背部腸繫膜（dorsal mesenteries）發育形成？

 大網膜（Greater omentum）  小網膜（Lesser omentum）

 固有腸繫膜（Mesentery proper）  結腸繫膜（Mesocolon）

ans lesser omentum

31 分娩時，從連接胎盤一端的臍帶切口流出的血液源自下列何者？

 胎兒的動脈血及靜脈血 母體的動脈血及胎兒的靜脈血

 胎兒的動脈血及母體的靜脈血 胎兒和母體的動脈血及靜脈血

A!!!

READ THE QUESTION CAREFULLY!

PLACENTA AS PARTITION!

BOTH ARTERY AND VEIN ARE OF THE BABY!

35 有關腦下垂體細胞（pituicytes），下列敘述何項正確？

 此細胞位於腦下垂體前葉（pars distalis）

 此細胞分泌催產素（oxytocin）與抗利尿激素（ADH/vasopressin）

 此細胞具有Herring 小體（Herring bodies）

 此細胞屬神經膠細胞（neuroglial cell

D

A pituicyte is a glial cell of the posterior pituitary.

They generally stain dark purple, and are among the easiest structures to identify in the region (pars nervosa of the posterior pituitary). ^[1][2]

They are similar to the astrocytes/glial cells of the CNS.

The ansa cervicalis (or ansa hypoglossi in older literature) is a loop of nerves that are part of the cervical plexus. It lies superficial to the internal jugular vein in the carotid sheath.

Branches from the ansa cervicalis innervate three of the four infrahyoid muscles: thesternohyoid muscle, the sternothyroid muscle, and the omohyoid muscle.

26 下列有關頸襻（ansa cervicalis）之敘述，何者錯誤？

 其分枝支配肩胛舌骨肌（omohyoid muscle）之上段

 其上根（superior root）源自於第一頸椎神經之腹側枝（ventral ramus）

 貼附於頸動脈鞘（carotid sheath）前外方

 其分枝鎖骨上神經（supraclavicular nerves）負責部分頸部皮膚之感覺

ans D

it is a motor nerve!

The ansa cervicalis (or ansa hypoglossi in older literature) is a loop of nerves that are part of the cervical plexus. It lies superficial to the internal jugular vein in the carotid sheath.

Branches from the ansa cervicalis innervate three of the four infrahyoid muscles: thesternohyoid muscle, the sternothyroid muscle, and the omohyoid muscle.

26 下列有關頸襻（ansa cervicalis）之敘述，何者錯誤？

 其分枝支配肩胛舌骨肌（omohyoid muscle）之上段

 其上根（superior root）源自於第一頸椎神經之腹側枝（ventral ramus）

 貼附於頸動脈鞘（carotid sheath）前外方

 其分枝鎖骨上神經（supraclavicular nerves）負責部分頸部皮膚之感覺

ans D

it is a motor nerve!

almost all the other muscles are inserted at the site as their name implies.

the SO and the IO are special ones.

the SO inserted at the 外後上方

the IO inserted at the 外後 下方

connection to hepatic sinusoid:

1. portal vein

2. cental vein

3. hepatic artery

note that the central vein empties into the sublobular vein and then to the hepatic vein!

the sublobular and hepatic are in no direct connection to the hepatic sinusoids!

17 右心房的動脈供應主要來自下列何者？

 右冠狀動脈

 右冠狀動脈的邊緣枝（marginal branch）

 左冠狀動脈的迴旋枝（circumflex branch）

 左冠狀動脈的前室間枝（anterior interventricular branch

ANS A!!!!!

房 IS REFERRING TO ATRIUM!!!!

RIGHT VENTRICAL IS SUPPLY BY D/ANTERIOR INTERVEN BRANCH

15 下列何者為尿道外括約肌（external urethral sphincter）所在處？

 膀胱頸 膜部尿道 前列腺尿道 陰莖部尿道

ANS B

AT THE BLADDER NECK: IT IS THE INTERNAL URETHRAL SPHINCTER

14 下列何者會直接跨越輸尿管？

 卵巢 輸卵管 輸精管 儲精囊

STRUCTURE ABOVE THE URETER

MALE: 輸精管

FEMALE: UTERINE ARTERY

STRUCTURE BENEATH THE URETER"

COMMON ILIAC ARTERY

下列何者的肌腱會從足底長韌帶（long plantar ligament）前端兩附著點間穿過？

 腓短肌（peroneus brevis）  腓長肌（peroneus longus）

 脛後肌（tibialis posterior）  脛前肌（tibialis anterior）

PERONEUS LONGUS

6 下列上肢肌肉中，何者止（insertion）於皮膚？

 掌長肌（palmaris longus）  掌短肌（palmaris brevis）

 小魚際肌（hypothenar muscles）  魚際肌（thenar muscles

ANS PALMARIS BREVIS

5 實施中心靜脈壓（CVP）注射時，須摸到股動脈脈搏，在何處下針？

 脈搏處內側 脈搏處外側 脈搏處 脈搏處下方

ANS A

VAN;

VEIN, ARTERY, NERVE

VEIN MOST MEDIAL!

2 下列關於直接型腹股溝疝氣（direct inguinal hernia）的敘述何者錯誤？

 發生於腹壁下動脈（inferior epigastric artery）內側區域

 發生於內側腹股溝窩（medial inguinal fossae）

 腹腔內構造常由腹股溝深環（deep inguinal ring）脫出

 發生於海氏三角（Hesselbach triangle）

ANS C

THE DEEP INGUINAL RING IS ASSOCIATED WITH INDIRECT INGUINAL HERNIA!

THE MEDIAL INGUINAL FOSSA IS RELATED TO DIRECT INGUINAL HERNIA

The medial inguinal fossa is a depression located within the inguinal triangle on the peritoneal surface of the anterior abdominal wall between the ridges formed by the lateral umbilical fold and the medial umbilical ligament, corresponding to the superficial inguinal ring.

There are two major classes of herniation: supratentorial and infratentorial. Supratentorial herniation is of structures normally above the tentorial notch and infratentorial is of structures normally below it.^[4]

• Supratentorial herniation

1. Uncal (transtentorial) NOTE: TEMPORAL LOBE MOST FREQUENTLY INVOLVED
2. Central
3. Cingulate (subfalcine)
4. Transcalvarial

• Infratentorial herniation

5. Upward (upward cerebellar or upward transtentorial)
6. Tonsillar (downward cerebellar)

The deep cervical fascia of the neck includes four parts:

• The investing layer (encloses the SCM and Trapezius)
• The carotid sheath (encloses the vascular region of the neck)
• The pretracheal fascia (encloses the visceral region of the neck)
• The prevertebral fascia (encloses the vertebral region of the neck)

Contents

The four major structures contained in the carotid sheath are:

• the common carotid artery as well as the internal carotid artery
• internal jugular vein
• the vagus nerve(CN X)
• the deep cervical lymph nodes.

調查 100 位女 ， 學生 其平均身高為 156 ， 公分 標準差為 6.5 ， 公分 試問女學生群體平均身高 95%信賴

區間為何？

 155.4-156.7  154.7-157.3  149.5-162.5  143.5-169.2

STEP 1

6.5 DIVIDED BY THE SQUARE ROOT OF 100 ( THE SAMPLE SIZE)

= 0.65

THIS IS OUR STANDARD ERROR

SE= SD/ SQ ROOT OF SAMPLE SIZE

THE MEMORIZE 1.96 (FOR 95% CONFIDENCE INTERVAL)

MEAN -/+ 1.96X 0.65

= 156 -/+ 1.27

84 在停經後婦女使用 hormone replacement therapy（HRT）和子宮內膜癌的個案對照研究中，某醫院過

20 去 年來患有子宮內膜癌的已停經婦 400 女 ，人 並選取了 800 名對照組。經進一步資料 ， 分析 發現

病例組中有 250 人及對照組中有 250 人曾接受過至少 6 個月的 HRT。請問使用 HRT 而得到子宮內膜

癌的危險勝算比（odds ratio）是多少？

 1.3  2.0  3.7  5.0

3.7

400-250=150

800-150=550

(250/150)/ (250/550)

= 550/150

=3.7

Differences between jejunum and ileum

There is no line of demarcation between the jejunum and the ileum. There are, however, subtle differences between the two.

• The ileum has more fat inside the mesentery than the jejenum
• While the length of the intestinal tract contains lymphoid tissue, only the ileum has abundant Peyer's patches, unencapsulated lymphoid nodules that contain large numbers of lymphocytes and other cells of the immune system.

JEJUNUM THICKER, MORE PLICA CIRCULARES

ILEUM THINNER, MORE ARTERIAL ARCADE AND PEYER'S PATCH

Innervation of foot

FUNCTIONAL COMPARTMENT

EFFERENT IN THE CENTER

AFFARENT ON THE OUTSIDE

GSE MEDIAL MOST

GSA MOST LATERAL

lateral pterygoid muslce:

the only mastication muscle that :

Depresses the mandible and protrudes it forward for opening of the jaw.

MOTOR NERVE: CN III, IV, VI

SENSORY : O AND M OF TRIGEMINAL NERVE

STRUCTURE IN THE CAVERNOUS SINUS

REVIEW OF THE 12 CRANIAL NERVE

NOTE THE OBTURATOR NERVE = ANT AND POST BRANCH = DIVIDED BY THE ADDUCTOR BREVIS!

IT LIES IN FRONT OF OBTURATOR EXTERNUS MUSCLE

FEMORAL VEIN AND ARTERY

SAPHENOUS NERVE

Boundary

It courses between the anterior compartment of thigh and the medial compartment of thigh, and has the following boundaries:

• anteriorly and laterally - the Vastus medialis.
• posteriorly - the Adductor longus and the Adductor magnus.
• roof and medially- the sartorius.

GREAT CARDIAC VEIN " SA HARAP

MIDDLE CARDIAC VEIN SA LIKOD