50 一位25 歲女士，生產史為G3P2，目前懷孕7 週，主訴陰道有出血現象，於是醫師安排陰道超音波檢查，確定在子宮內有一胚囊同時發現胎兒心臟跳動的現象，但是左側子宮附屬組織有一3 公分的水囊，請問下列敘述何者最佳？

此病患可能同時有子宮內懷孕及子宮外孕此病患應該被告知即將無法繼續懷孕

此水囊應該及早手術拿掉妊娠第一期（first trimester）陰道出血並非少見

D

55 下列何者不是嬰兒斜頸（torticollis）的適當治療方法？

患側邊頸部肌肉的牽拉運動健側邊頸部肌肉的功能訓練

嚴重者可以手術去除纖維化肌肉以石膏固定頸部

D

56 下列何者較適合用於心臟移植手術後病患的運動訓練強度？

無氧閾值

最大心率的百分之八十五

最大心率的百分之六十

（運動耐受測試時的最大心率－休息時心率）×（40 - 60）%＋休息時心率

A

ANAEROBIC THRESHOLD, YOU DONT WANT TO PUSH THE PATIENT TO ANAEROBIC ZONE

57 下列何種截肢最常使用內側開窗戶式套筒（medial opening socket）？

賽姆氏（Syme’s amputation） 脛骨（transtibial amputation）

股骨（transfemoral amputation） 賽柏氏（Chopart amputation）

A

Syme's Amputation

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- Discussion:
- includes ankle disarticulation, removal of malleoli, & anchoring heel pad to the wt bearing surface) allows execellent gait
with a cosmetic prosthesis;
- symes amputations will not heal w/o palpable posterior artery pulse;
- surgery may be performed in 2 stages;
- most common indication for this is infection;
- ankle is disarticulated in the first stage and the amputation is revised approximately 6 weeks later during the second stage;
- components of the 2nd stage include resection of the malleoli flush w/ joint surface, fixation of the fat pad to residual bone,
and revision of redundant skin;
- this amputation allows for intermittent wt bearing; however, skin break down may occur if a prosthesis is used on a regular basis;
- majority of patients w/ Syme's amputation will require prothesis designed to relieve end weight bearing;