(C) | 1. |
¤@¦ì53·³¨k©Ê¯f¤H¡A¨ä¦å¶tȬ°2.7 mmol/L (°Ñ¦ÒÈ 2.15~2.58 mmol/L), °Æ¥Òª¬¸¢²üº¸»X¬° 45 pg/mL (°Ñ¦ÒÈ12.0~65.0 pg/mL)¡A¤U¦Cþ¤@¶µ¶·¦C¬°Å²§O¶EÂ_?(1)ºC©Ê¦×ªÞ¸~¯f (Chronic granulomatous disease)¡F(2)®a±Ú©Ê§C§¿¶t°ª¦å¶t¯g (familial hypocalciuric hypercalcemia)¡F(3)¤û¥¤¡ÐÆP¾¯¯g (Milk-alkali syndrome)¡F(4)¥Òª¬¸¢¥\¯à§C¤U (Hypothyroidism)¡F(5)®wªY¤ó¯gÔ¸s (Cushing's syndrome)
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A. | (1)+(2)+(4) |
B. | (2)+(3)+(5) |
C. | (1)+(2)+(3) |
D. | (3)+(4)+(5) |
E. | (1)+(2)+(3)+(4)+(5) |
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(B) | 2. |
¦³Ãö¥Òª¬¸¢Åè½èÀùªº¯S©Ê¡A¤U¦Cþ¤@¶µ¥¿½T?(1)¥Òª¬¸¢Åè½èÀù(Medullary thyroid carcinoma)¬ù¦û©Ò¦³¥Òª¬¸¢Àùªº 5 ~ 10% ¡F(2)¬ù20% ¥Òª¬¸¢Åè½èÀù¯f¤H¦³®a±Ú¯f¥v¡F(3)²Ä¤G«¬¦hµo©Ê¤º¤Àªc¸~½F(Multiple endocrine neoplasia, MEN, type 2) ¯f¤H±`¨£¦³ ¥Òª¬¸¢Åè½èÀù¡BµÇ¤W¸¢¥Ö½è¸~½F¡B°Æ¥Òª¬¸¢¸~½F¡F(4)²Ä¤G«¬¦hµo©Ê¤º¤Àªc¸~½F (MEN type2)ªº®a¤HÀ³¸Ó°µ°ò¦]¿zÀË¡AY¦³RET°ò¦]¬ðÅÜ¡AÀ³µ¥¯f¤H¦¨¦~«á«Øij¥Òª¬¸¢¤Á°£¡F(5)¥Òª¬¸¢Åè½èÀù¥i¯à¦³²§¦ì©Ê«PµÇ¤W¸¢¥Ö½è¿E¯À(ectopic ACTH) ¤Àªc¦Ó¾ÉP®wªY¦¡¯gÔ¸s (Cushing's syndrome)
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A. | (1)+(2)+(3)+(4) |
B. | (1)+(2)+(5) |
C. | (2)+(3)+(4) |
D. | (3)+(4)+(5) |
E. | (1)+(5) |
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(D) | 3. |
¤@¦ì64·³¨k©Ê¯f¤H¡A¤w¦³¦h¦~°ª¦åÀ£¡A³Ìªñ¥b¦~¨Ó¦åÀ£¤£©ö±±¨î¡A¥B±`¦³°}µo©Ê¤ß±ª¡BÀYµh¡B«_¦½µ¥¯gª¬¡A§AÃhºÃ¯f¤H¦³¶Ý¹T²ÓM½F(pheochromocytoma)¡A½Ð°Ý¤U¦Cþ¤@¶µ¥¿½T?
|
A. | ¯f¤Hì¨Ó¦³¨Ï¥Îªº§Q§¿¾¯(diuretics)¤Î¤TÀô§Ü¼~Æ{ÃĪ«(tricyclic antidepressants)¹ïÀËÅ礣·|¼vÅT¡A©Ò¥H¤£»Ýn¥ý¼È°±¨Ï¥Î |
B. | ´ú¶q¦å¼ß¤¤ªº´åÂ÷«áµÇ¤W¸¢Åè¯À(Plasma free metanephrines)¨ã¦³³Ì°ªªº¯S²§©Ê¡A¦ý±`·|¦³¦]ÀR¯ß©â¦å®É³y¦¨ªº°°¶§©Ê(venipuncture-induced false-positive)µ²ªG |
C. | ¯f¤H¦³¤ß±ª¯gª¬¡AÀ³¸ÓÀu¥ý¨Ï¥Î¤A«¬µÇ¤W¸¢¨üÅé§í¨î¾¯ (£]-adrenergic blockers)¡A¥HÁקK¤ß¸õ¹L³t¡A³y¦¨¦MÀI |
D. | ¬ù¦³10%ªº¶Ý¹T²ÓM½F¬O´c©Êªº¡A°£¤F¶}¤M¥H¥~¡A¥i¥H¦Ò¼{¥H200 mCiªº131 I-MIBG ªvÀø |
E. | ¤j¬ù¦³25-33% ªº¶Ý¹T²ÓM½F¯f¤H¦³¸ò¿ò¶Ç¦³Ãöªº°ò¦]¬ðÅÜ¡A¨ä¤¤¦³SDHB°ò¦]¬ðÅܪº¡A²£¥Í´c©ÊÅܤƪº¥i¯à©Ê³Ì§C |
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(A) | 4. |
¤U¦Cþ¤@¶µ°¦åÀ£ÃÄ·|¨Ï¦å¼ßîÇ©Tି@«× (Plasma aldosterone concentration , PAC)»P¦å²M±i¤O¯À¬¡©Ê(plasma renin activity, PRA)¤ñÈ(Aldosterone-renin-ratio, ARR) ¤W¤É?
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A. | ¤A«¬µÇ¤W¸¢¨üÅé§í¨î¾¯ (£]-adrenergic blockers) |
B. | ¥Ò«¬µÇ¤W¸¢¨üÅé§í¨î¾¯ (£\-adrenergic blockers) |
C. | ¦åºÞºò±i¯ÀÂà´«úC§í»s¾¯ (angiotensin-converting enzyme inhibitors, ACEi) |
D. | ¶tÂ÷¤l«ú§Ü¾¯ (calcium antagonists) |
E. | §Q§¿¾¯ (diuretics) |
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(D) | 5. |
¦³Ãö¸£¤U««Åé¥\¯àÀˬd¡A¥H¤Uþ¤@¶µ´yz¬O¥¿½Tªº¡H
(°Ñ¦ÒÈ: ªc¨Å¿E¯À¡]Prolactin¡^1.9~25 ng/m¢Ú¡F¥Íªø¿E¯À¡]Growth hormone, GH¡^ < 8 ng/mL¡F¥Ö½è¾J¡]cortisol¡^8 am 5~25 £gg/dL¡B4 pm 2.5~12.5 £gg/dL¡FµÇ¤W¸¢¥Ö½è¿E¯À¡]ACTH¡^7.4~57.3 pg/mL; ¹[¡]potassium, K¡^3.5~5.1 mmol/L¡F´åÂ÷«¬¥Òª¬¸¢¯À (fT4) 0.89~1.76 ng/dL¡F¥Òª¬¸¢¨ë¿E¯À (TSH) 0.4~4 £gIU/mL)
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A. | µ¹¤©¤fªA75§J¸²µå¿}¡AGH¦b0¤À¡B30 ¤À¡B60¤À§O¬°15 ng/mL¡B14 ng/mL¡B12 ng/mL¡A¥i¥H±Æ°£ªÏºÝªÎ¤j¯g(acromegaly)¡C |
B. | ¯f¤Hªºªc¨Å¿E¯ÀȬ° 50 ng/mL¡A¥i¥H¶EÂ_¬°ªc¨Å¿E¯À½F(prolactinoma)¡C |
C. | ¯f¤Hªº8 am cortisol ¬°30 £gg/dL¡A±ß¤W 11 pm µ¹¤© ¤fªAdexamethasone 1 mg «á¡A²Ä¤G¤Ñ¤W¤È 8 am ªºcortisol Ȭ° 18 £gg/dL¡A¥i¥H±Æ°£®wªY¤ó¯g¡C |
D. | ¯f¤H8 am ACTH 96 pg/mL¡Bcortisol 28 £gg/dL¡F4 pm cortisol 25 £gg/dL¡F¢Ù 2.7 mmol/L¡F¶·¤p¤ß¬O§_¦³ ectopic ACTH syndrome¡C |
E. | ¯f¤Hªº fT4 ¬° 0.86 ng/dL¡BTSH 9 £gIU/mL¡A¦¹¯f¤H¥i¯à¦³¥Òª¬¸¢¨ë¿E¯À½F¡C |
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(B) | 6. |
¦³Ãö§¿±Y¯g¡]diabetes insipidus, DI¡^ªº¶EÂ_»PªvÀø¡A¤U¦Cþ¤@¶µ¥¿½T¡H
|
A. | §¿±Y¯gªº©w¸q¬°¦b¤£¤ôªº±¡ªp¤U¡A¨C¤Ñ¨C¤½¤çÅ髧¿¶q¤j©ó60 mL (¨Ò¦p: 70¤½¤ç«¡A§¿¶q¶W¹L¨C¤Ñ 4200 mL)¥B§¿º¯³zÀ£¤p©ó250 mosmol/L¡C |
B. | ¯f¤H¦³§¿±Y¯g¡A¥B¨äplasma arginine vasopressin (AVP) < 1 pg/mL¡AÀ³¸Ó¦w±Æ¸£¤U««Åé®ÖºÏ¦@®¶Àˬd¡C |
C. | §¿±Y¯gªº¯f¤H¦pªG¨ä¸£¤U««Åé®ÖºÏ¦@®¶¼v¹³Åã¥Ü¨ä«á¸¦³¥Õ¥Õ«GÂI¡A¤@©w¬O¤¤¼Ï©Ê§¿±Y¯g (central DI)¡C |
D. | ÃhºÃ¦³§¿±Y¯gªº¯f¤H¦b°µ¤ô´ú¸Õ®É¡A§¿¶q´î¤Ö¡A§¿º¯³zÀ£¼W¥[¡A¦¹¯f¤H¤ñ¸û¹³¬O¤¤¼Ï©Ê§¿±Y¯g (central DI)¡C |
E. | µÇ·½©Ê§¿±Y¯g(nephrogenic DI)À³¸Ó¨Ï¥Îdesmopressin (DDAVP)ªvÀø¡C |
|
(A) | 7. |
¤@¦ì70 ·³¤k©Ê¯f¤H¡A¦]¬°¥ð§J³Q°e¦Ü«æ¶E¡A¨äÀËÅçȦp¤U: Na 125 mmol/L¡Bglucose AC 68 mg/dL¡BACTH 20 pg/mL¡Bcortisol 10 £gg/dL¡BfT4 0.5 ng/dL¡BTSH 0.1 £gIU/mL¡A½Ð°Ý¤U¦Cþ¤@¶µªvÀøÀ³¸ÓÀu¥ýµ¹¤©¡H
(°Ñ¦ÒÈ: ¥Ö½è¾J¡]cortisol¡^8 am 5~25 £gg/dL¡B4 pm 2.5~12.5 £gg/dL¡FµÇ¤W¸¢¥Ö½è¿E¯À¡]ACTH¡^7.4~57.3 pg/mL; ¶u (sodium, Na) 136~145 mmol/L¡F ªÅ¸¡¦å¿} (glucose AC) 70~100 mg/dL¡F´åÂ÷«¬¥Òª¬¸¢¯À (fT4) 0.89~1.76 ng/dL¡F¥Òª¬¸¢¨ë¿E¯À (TSH) 0.4~4 £gIU/mL)
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A. | Hydrocortisone, intravenous |
B. | Thyroxine |
C. | 3% NaCl |
D. | 50% glucose water (G/W) |
E. | Prednisolone, per os |
|
(E) | 8. |
¤U¦C¦]¯À¥i¯à³y¦¨euthyroid hyperthyroxinemia¡A°£¤F?
|
A. | Resistance to thyroid hormone |
B. | Pregnancy |
C. | Amiodarone |
D. | Liver cirrhosis |
E. | Malnutrition |
|
(C) | 9. |
¤@¦ì25·³¤k©Ê¯f¤H¡A¦]¬°«eÀV³¡¸~µh¨Ó¶E¡A¨Åé¶E¹îµo²{¥Òª¬¸¢¦³¸~¶ô¡B¨ãÀ£µh¡A¦ýµL¥Ö½§¬õ¼ö²{¶H¡C¯f¤H¨â¶g«e¦³¤W©I§l¹D·P¬V¯gª¬¡C¦oªºÀËÅç¼ÆȦp¤U: fT4 2.0 ng/dL (°Ñ¦ÒÈ: 0.89~1.76 ng/dL)¡BTSH 0.3 £gIU/mL (°Ñ¦ÒÈ 0.4~4 £gIU/mL)¡BWBC 7800 /£gL¡C¶WµªiÀˬdÅã¥ÜÀ£µh³B¦³§½³¡§C°jµ«×ÅܤơB²Ó°w¬ï¨ë²ÓM¾ÇÀˬdÅã¥Ü¦³¦h®Ö©Ê¥¨²ÓM (multinucleated giant cell)¡A½Ð°ÝÀ³¸Óµ¹¤©¤U¦Cþ¨Ç³B¸m?
|
A. | µ¹¤©§Ü¥Í¯ÀªvÀø |
B. | µ¹¤©§Ü¥Òª¬¸¢ÃĪ«ªvÀø |
C. | µ¹¤©Ãþ©T¾JªvÀø |
D. | À³¸Ó¥ß§Y¦w±Æ¹¹DÄá¼v (esophagogram) |
E. | À³¸Ó¥ß§Y¦w±Æ¹q¸£Â_¼hÀˬd |
|
(D) | 10. |
¤@¦ì43·³¨k©Ê¯f¤H³Q¶EÂ_¦³¥Òª¬¸¢¨Å¬ðÀù(thyroid papillary cancer)¡A¨ä¸~½F¦³2.5¤½¤À¡A¤w¸g¦³§½³¡³n²Õ´«I¥Ç¤ÎÀV³¡²O¤Ú¸¢Âಾ¦ýµL»·ºÝÂಾ¡A¤U¦Cþ¤@¶µ±Ôz¥¿½T?
|
A. | ¦¹¯f¤HªºÀù¯g¤À´ÁÄÝ©ó²Ä¤T´Á |
B. | ¦¹¯f¤Hªº¤¦~¦s¬¡²v¤j¬ù¬°70% |
C. | ¤â³N«áÀ³¸Óµ¹¤©2-5 mCiªº©ñ®g©Ê¸K°µ±½´y¡A½T©w¬O§_¦³»·ºÝÂಾ«á¦A¦Ò¼{¬O§_»Ýnµ¹¤©©ñ®g©Ê¸KªvÀø |
D. | ¸g¹L¤â³N¤Î¥²nªº©ñ®g©Ê¸KªvÀø«á¡AÀ³¸Óµ¹¤©¥Òª¬¸¢¯À¸É¥R¡A¥Hºû«ù¯f¤Hªº¥Òª¬¸¢¥\¯à©ó¥¿±`½d³ò¡A¨äTSHÀ³¸Ó¶V§C¶V¦n |
E. | ¯f¤H±µ¨üªvÀø¾¯¶qªº©ñ®g©Ê¸K«á¤§±½´y¨S¦³¬Ý¨ì¦³Äá¨ú©ñ®g©Ê¸Kªº¯f¨_¡A¨äthyroglobulin ¬° 20 ng/mL¡A¦¹¯f¤H¥i¥H½T©w¨S¦³¥Òª¬¸¢Àù¦Aµo |
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