29 一位2個月女嬰因為持續劇烈咳嗽3週與發燒1週就診，身體檢查發現臉部有些小出血點，咽部正常，雙側肺部呼吸音正常，血液檢查白血球17,500/mm3，segment 15%，monocyte 3%，lymphocyte 82%，platelet 365,000/mm3。上述資訊中，那一項最不符合百日咳的典型表現？

白血球分類 肺部呼吸音 持續發燒 發病年齡

ans pesistent fever

http://www.cdc.gov.tw/ct.asp?xItem=6474&ctNode=1733&mp=1

百日咳常發生於5歲以下兒童

fever is definitely not persistent!

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30 一位2歲兒童因首次罹患左側中耳炎接受amoxicillin 90 mg/kg/day q8h治療，3天後仍然持續發燒，並因耳膜破裂出現膿液，膿液的檢查發現有革蘭氏陰性細菌。所發現的細菌最可能是下列那一種？

Streptococcus pneumoniae Haemophilus influenzae

Pseudomonas aeruginosa Escherichia coli

answre is H influenza

this is not a case of malignant OM: if OM then p aeruginosa is the right answer

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31 承上題，引起急性中耳炎的常見革蘭氏陰性細菌對amoxicillin產生抗藥性最常見的原因是下列那一項？

Penicillin結合蛋白與抗生素的結合力下降 抗生素對細菌的穿透力下降

細菌分泌酵素分解抗生素 細菌加快排出抗生素

ANS

細菌分泌酵素分解抗生素

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33 一位40歲婦女，最近1年在兩頰發生大塊均勻的褐色斑（brown patches），如圖所示。此斑會因曝曬陽光而惡化，其最可能的診斷為：

日光性小痣（solar lentigo）

肝斑（chloasma）

發炎後色素沈澱（post-inflammatory hyperpigmentation）

雀斑（freckles）

ANS CHLOASMA

solar lentigo

CHLOASMAMelasma (also known as "Chloasma faciei"^[1]:854 or the mask of pregnancy^[2] when present in pregnant women) is a tan or dark skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral or patch contraceptives or hormone replacement therapy (HRT) medications. It is also prevalent in men and women of Native American descent (on the forearms) and in men and women of German/Russian and Jewish descent (on the face).

POST INFLAMMATORY

FRECKLES