一０六年度內專筆試題

一０六年度內科專科醫師考試筆試題 -- 免疫科

(B) 1. 下列有關過敏原引發蕁痲疹致病機轉的配對中，何者最正確？

A. Pollens－bradykinin-mediated

B. Radiocontrast media－mast cell-mediated

C. Opiate－IgE-dependent

D. NSAIDs－complement-mediated

E. Cold exposure－macrophage activation

(C) 2. 32歲女姓患者過去有二次流產記錄。二天前右下腿突然腫脹疼痛，被懷疑為蜂窩組織炎。但經抗生素治療三天之後無顯著改善。血清學檢查發現ANA1:1280 speckled pattern, C3 57.6 mg/dL, C4 7.5 mg/dL, anti-dsDNA 473 IU/mL, 血液學檢查發現pancytopenia。請問這位患者右下腿突然腫脹的最可能原因為何？

A. Lupus nephritis

B. Cellulitis

C. Anti-phospholipid syndrome

D. Lymphoedema

E. Sciatica

(D) 3. 49歲女姓患者，二年前開始發現雙側手指在冬天會變白後變紫。最近三個月雙手有關節酸痛及僵硬，嘴巴張開受限及吃東西有時會嗆到。在懷疑罹患自體免疫疾病之下，請問下列的何種自體抗體檢查對疾病的診斷最有幫助？

A. Anti-double stranded DNA

B. Anti-Sjogren's-syndrome-related antigen A

C. Anti-cyclic citrullinated peptide antibody (Anti-CCP antibody)

D. Anti-topoisomerase 1

E. Anti-phospholipid

(E) 4. 24歲男性患者，在長途開車時會有腰酸背痛。下車活動20分鐘之後會改善。另外，早上剛起床時全身會僵硬。請問下列的何種檢查對疾病的診斷最有幫助？

A. HLA-B27

B. Whole body bone scan

C. Rheumatoid factors (RFs)

D. Anti-nuclear antibodies (ANAs)

E. MRI

(C) 5. 61歲女姓發覺最近臉部及手部指節處有紅斑出現。起床時無法立即站起來，必須以雙手支撐才能站起來。抽血發現AST 108U/L, ALT 32U/L, CK 659 U/L。請問要確定診斷，下列的何種檢查對疾病的診斷最具決定性？

A. MRI

B. Electromyolography (EMG)

C. Muscle biopsy

D. Myoglobulin

E. Whole body CT scan

(B) 6. 82歲男性患者，在半夜睡覺時突然發生左膝蓋劇痛。在急診抽血發現uric acid 6.1 mg//dL, ESR 42 mm/1h, CRP 4.6 mg/dL。關節液檢查：WBC 8480/HPF,發現有 rhomboid and plate-like crystal (+),但無needle-shaped crystal.請問最有可能的疾病診斷為何？

A. Acute gouty arthritis

B. Pseudo-gout

C. Septic arthritis

D. Osteoarthritis

E. Polymyalgia rheumatica

(A) 7. 以xanthine oxidase inhibitor "Allopurinol"治療痛風時，必須事前檢測何種基因？

A. HLA-B*5801

B. HLA-DR4

C. HLA-B*1502

D. HLA-B27

E. HLA-B51

(E) 8. 45歲男性患者為B肝帶原者。最近五天全身有多處關節痛發生。到醫院檢查發現ESR 34 mm/1h, CRP 2.1 mg/dL, RF 84 IU/mL。被懷疑有rheumatoid arthritis。請問下列的何種檢查對疾病的鑑別診斷最有幫助？

A. Ferritin

B. Bilateral hand X-ray film

C. Cryoglobulin

D. IgG RFs

E. Anti-CCP

(C) 9. 下列有關血管炎症候群(vasculitis syndrome)與臨床相關的配對中，何者最正確？(1)Granulomatosis with polyangiitis－usually cANCA (+)；(2)Takayasu arteritis－difference in bilateral. brachial blood pressure；(3)Giant cell arteritis－high incidence in young age group；(4)Eosinophilic granulomatosis with polyangiitis－high incidence in old age group；(5)Henoch-Schonlein purpura－increase in serum IgA；(6)Polyarteritis nodosa－chronic pancreatitis；(7)Cryoglobulinemic vasculitis－associated with hepatitis C；(8)Behcet's disease－usually pANCA (+)；(9)Microscopic polyangiitis－usually associated with sinusitis

A. (1)+(2)+(3)

B. (3)+(4)+(6)

C. (1)+(5)+(7)

D. (2)+(7)+(8)

E. (1)+(3)+(9)

(E) 10. 原發性Sjogren's syndrome 有多種唾液腺以外的症狀表現。請問下述的症狀的組合中，何者最為正確？(1)Interstitial lung fibrosis；(2)primary biliary cirrhosis；(3)uveitis；(4)scleritis；(5) autoimmune hepatitis；(6)peripheral neuropathy；(7)acute pancreatitis；(8)renal tubular acidosis；(9)amyloidosis；(10)atopic dermatitis

A. (1)+(2)+(3)

B. (2)+(4)+(5)

C. (1)+(6)+(7)

D. (4)+(9)+(1)

E. (5)+(6)+(8)

< 一０六年度試題目錄 >

(B)	1.	下列有關過敏原引發蕁痲疹致病機轉的配對中，何者最正確？
		A.	Pollens－bradykinin-mediated
		B.	Radiocontrast media－mast cell-mediated
		C.	Opiate－IgE-dependent
		D.	NSAIDs－complement-mediated
		E.	Cold exposure－macrophage activation

(C)	2.	32歲女姓患者過去有二次流產記錄。二天前右下腿突然腫脹疼痛，被懷疑為蜂窩組織炎。但經抗生素治療三天之後無顯著改善。血清學檢查發現ANA1:1280 speckled pattern, C3 57.6 mg/dL, C4 7.5 mg/dL, anti-dsDNA 473 IU/mL, 血液學檢查發現pancytopenia。請問這位患者右下腿突然腫脹的最可能原因為何？
		A.	Lupus nephritis
		B.	Cellulitis
		C.	Anti-phospholipid syndrome
		D.	Lymphoedema
		E.	Sciatica

(D)	3.	49歲女姓患者，二年前開始發現雙側手指在冬天會變白後變紫。最近三個月雙手有關節酸痛及僵硬，嘴巴張開受限及吃東西有時會嗆到。在懷疑罹患自體免疫疾病之下，請問下列的何種自體抗體檢查對疾病的診斷最有幫助？
		A.	Anti-double stranded DNA
		B.	Anti-Sjogren's-syndrome-related antigen A
		C.	Anti-cyclic citrullinated peptide antibody (Anti-CCP antibody)
		D.	Anti-topoisomerase 1
		E.	Anti-phospholipid

(E)	4.	24歲男性患者，在長途開車時會有腰酸背痛。下車活動20分鐘之後會改善。另外，早上剛起床時全身會僵硬。請問下列的何種檢查對疾病的診斷最有幫助？
		A.	HLA-B27
		B.	Whole body bone scan
		C.	Rheumatoid factors (RFs)
		D.	Anti-nuclear antibodies (ANAs)
		E.	MRI

(C)	5.	61歲女姓發覺最近臉部及手部指節處有紅斑出現。起床時無法立即站起來，必須以雙手支撐才能站起來。抽血發現AST 108U/L, ALT 32U/L, CK 659 U/L。請問要確定診斷，下列的何種檢查對疾病的診斷最具決定性？
		A.	MRI
		B.	Electromyolography (EMG)
		C.	Muscle biopsy
		D.	Myoglobulin
		E.	Whole body CT scan

(B)	6.	82歲男性患者，在半夜睡覺時突然發生左膝蓋劇痛。在急診抽血發現uric acid 6.1 mg//dL, ESR 42 mm/1h, CRP 4.6 mg/dL。關節液檢查：WBC 8480/HPF,發現有 rhomboid and plate-like crystal (+),但無needle-shaped crystal.請問最有可能的疾病診斷為何？
		A.	Acute gouty arthritis
		B.	Pseudo-gout
		C.	Septic arthritis
		D.	Osteoarthritis
		E.	Polymyalgia rheumatica

(A)	7.	以xanthine oxidase inhibitor "Allopurinol"治療痛風時，必須事前檢測何種基因？
		A.	HLA-B*5801
		B.	HLA-DR4
		C.	HLA-B*1502
		D.	HLA-B27
		E.	HLA-B51

(E)	8.	45歲男性患者為B肝帶原者。最近五天全身有多處關節痛發生。到醫院檢查發現ESR 34 mm/1h, CRP 2.1 mg/dL, RF 84 IU/mL。被懷疑有rheumatoid arthritis。請問下列的何種檢查對疾病的鑑別診斷最有幫助？
		A.	Ferritin
		B.	Bilateral hand X-ray film
		C.	Cryoglobulin
		D.	IgG RFs
		E.	Anti-CCP

(C)	9.	下列有關血管炎症候群(vasculitis syndrome)與臨床相關的配對中，何者最正確？(1)Granulomatosis with polyangiitis－usually cANCA (+)；(2)Takayasu arteritis－difference in bilateral. brachial blood pressure；(3)Giant cell arteritis－high incidence in young age group；(4)Eosinophilic granulomatosis with polyangiitis－high incidence in old age group；(5)Henoch-Schonlein purpura－increase in serum IgA；(6)Polyarteritis nodosa－chronic pancreatitis；(7)Cryoglobulinemic vasculitis－associated with hepatitis C；(8)Behcet's disease－usually pANCA (+)；(9)Microscopic polyangiitis－usually associated with sinusitis
		A.	(1)+(2)+(3)
		B.	(3)+(4)+(6)
		C.	(1)+(5)+(7)
		D.	(2)+(7)+(8)
		E.	(1)+(3)+(9)

(E)	10.	原發性Sjogren's syndrome 有多種唾液腺以外的症狀表現。請問下述的症狀的組合中，何者最為正確？(1)Interstitial lung fibrosis；(2)primary biliary cirrhosis；(3)uveitis；(4)scleritis；(5) autoimmune hepatitis；(6)peripheral neuropathy；(7)acute pancreatitis；(8)renal tubular acidosis；(9)amyloidosis；(10)atopic dermatitis
		A.	(1)+(2)+(3)
		B.	(2)+(4)+(5)
		C.	(1)+(6)+(7)
		D.	(4)+(9)+(1)
		E.	(5)+(6)+(8)