已有腎衰竭，考慮血鈣之高低時，不需以血液中之白蛋白值加以調整
治療高血鈣急症，使用bisphosphonate比使用calcitonin之效果較慢出現
副甲狀腺之增生腫大屬代償性，不應考慮手術切除
腎衰竭是做Sestamibi parathyroid scan檢查的禁忌症
ans B
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58 對於人類免疫不全病毒（human immunodeficiency virus）感染者，下列那一種情形不符合愛滋病（acquired immunodeficiency syndrome）診斷的定義？
卡波西肉瘤（Kaposi’s sarcoma）
肺囊蟲肺炎（Pneumocystis jiroveci pneumonia）
李斯特菌感染（Listeriosis）
食道念珠菌感染（esophageal candidiasis）
ans:C
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60 2009年4月於北美開始爆發新型流感的流行，使得全球對於流感更加重視，下列關於流感的敘述何者錯誤？
流感病毒可以分成A、B、C三種type，此次新型流感是A型H1N1
此新型流感病毒的基因是由人、豬、禽三種流感病毒之基因重組而成
病毒的抗原改變是造成流感大流行的主要因素
抗病毒藥物Amantadine作用於hemagglutinin，而Oseltamivir是neuraminidase的抑制劑，二者對A及B型流感均有效
ans D:
http://www.cdc.gov/h1n1flu/
According to the US Centers for Disease Control and Prevention, 100% of seasonal H3N2 and 2009 pandemic flu samples tested have shown resistance to adamantanes, and amantadine is no longer recommended for treatment of influenza.
A starting dose is often 100 mg once daily. All influenza B strains, many influenza A strains (and virtually all H1N1 "swine flu" strains) are resistant to amantadine, so a failure at this dose is likely due to resistance and not underdosing. For its anti-Parkinsonian effects, a starting dose of 300 mg once daily is normal, but can be increased up to 400 mg.
The mechanisms for amantadine's antiviral and antiparkinsonian effects appear unrelated.
The mechanism of Amantadine's antiviral activity involves interference with a viral protein, M2 (an ion channel),[15][16] which is required for the viral particle to become "uncoated" once taken inside a cell by endocytosis.
The mechanism of its antiparkinsonian effect is poorly understood. The drug has many effects in the brain, including release of dopamine and norepinephrine from nerve endings. It appears to be a weak NMDA receptor antagonist[17] as well as an anticholinergic.
The prodrug Oseltamivir is itself not virally effective; however, once in the liver, it is converted by natural chemical processes, hydrolysed hepatically to its active metabolite, the free carboxylate of oseltamivir (GS4071).[5]
Oseltamivir is a neuraminidase inhibitor, serving as a competitive inhibitor towards sialic acid, found on the surface proteins of normal host cells. By blocking the activity of the viral neuraminidase enzyme, oseltamivir prevents new viral particles from being released by infected cells
Antiviral Drugs for Treatment of Influenza
The neuraminidase inhibitors are the drugs of choice for treatment of 2009 H1N1 influenza and influenza-like illness in both children and adults in the U.S. at this time.
Oseltamivir - The neuraminidase inhibitor oseltamivir formulated as capsules or oral suspension (Tamiflu®) is FDA-approved for the treatment of uncomplicated acute influenza in patients 1 year and older who have been symptomatic for no more than 2 days. The FDA has issued an Emergency Use Authorization (EUA) authorizing treatment with oseltamivir of patients less than 1 year old with 2009 H1N1 influenza. In addition, the EUA authorizes treatment of patients symptomatic with 2009 H1N1 influenza for more than 2 days and patients sick enough to require hospitalization (see www.cdc.gov/h1n1flu/eua/tamiflu.htm).
Zanamivir - The neuraminidase inhibitor zanamivir formulated for oral inhalation (Relenza®) is FDA-approved for the treatment of influenza in patients 7 years of age and older who, similar to approved uses for oseltamivir, have uncomplicated illness and have been symptomatic for no more than 2 days. As with oseltamivir, the FDA has issued an EUA authorizing treatment with zanamivir of patients with 2009 H1N1 influenza who have been symptomatic for more than 2 days and patients sick enough to require hospitalization (see www.cdc.gov/h1n1flu/eua/relenza.htm ).
Peramivir - A third neuraminidase inhibitor peramivir formulated for intravenous (IV) administration is an investigational product currently being evaluated in clinical trials. As of October, 2009, safety and/or efficacy data from 1,891 patients with acute uncomplicated seasonal influenza A has been submitted to the FDA. Efficacy and safety have not been evaluated in hospitalized patients. Even though the data are insufficient to allow FDA approval, the FDA issued an EUA for treatment with peramivir of hospitalized patients with 2009 H1N1 influenza who have potentially life-threatening suspected or laboratory confirmed infection. Peramivir IV is available through the CDC upon request of a licensed physician. Under the EUA, treatment of adult patients with IV peramivir is approved only if: (1) the patient has not responded to either oral or inhaled antiviral therapy; (2) drug delivery by a route other than IV is not expected to be dependable or is not feasible; or (3) the clinician judges IV therapy is appropriate due to other circumstances. Treatment of pediatric patients is approved if either of the first two criteria apply.
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