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(E) 1.¯f¤H60·³¨k©Ê¦]¤@¤Ñ«e¦³«y¦å¡B©ü³Ö¤Î¤ß±ª¡A¦ñ¦³§C¦åÀ£ (74/40 mmHg) ¦Ó¦í°|¡C²z¾ÇÀˬd¡G·NÃѲM·¡ E4 M6 V5¡AT/P/R¡G37.4/100/18¡ABP¡G140/84 mmHg¡ASPO2¡G95% (ambient air ) ¡AÀVÀR¯ß«ã±i¡F¯Ý³¡µL²§±`ºV¶E¡A©I§lÁn¥¿±`¡A¤ßŦ¡GPMI ¦b¥ª²Ä¤­¦Ø¶¡¡A¤ß­µµL²§±`¡AµLÂø­µ¡AµL S3 ©Î S4¡F¨xŦ¥¿±`¡F¸}¡G¥ª¥k¯B¸~¡A¯S§O¥ª¤UªÏ¡CµLªS«ü©Îµoµµ¡CÀËÅçµ²ªG¡GRBC 5.45 M/cmm¡AHb 17.3 gm/dl¡AHct 48.7%¡AWBC 12.31K/cmm¡APlatelet 128 K/cmm¡AAlbumin 3.7 gm/dL¡AAST 36 u/L¡AALT 24 u/L¡AALP 206 u/L¡ABUN 17 mg/dL¡ACre 1.2 mg/dL¡AUA 9.8 mg/dL¡AABG PH 7.41 PaCO2 31.8 mmHg¡APaO2 68.4 mmHg¡ABE -3.1¡ASaO2 90.2¡A¤ß¹q¹Ï ¤Î¯Ý³¡X¥ú ¦p¹Ï¡G³o¦ì¯f¤HªºÁ{§É¶EÂ_¬O¡G1.¥ª¤ß°IºÜ¡C2.¥k¤ß°IºÜ¡C3.¸£¦åºÞªý¶ë¡C4.ªÍ°Ê¯ß®ê¶ë¡C5.¤U¾À¤ß¦Ù±ð¶ë¡C
A.1+2
B.3+4
C.1+5
D.2+3
E.2+4
 
(D) 2.¨M©w¤W­±¶EÂ_³Ì­«­nªº¬O¡G1.¨k©Ê60·³¡C2.¤ßŦÀˬd¡C3.¤ß¹q¹Ï¡C4.¥Í¤Æ¤Î¦å²GÀˬd¡C5.¯Ý³¡X¥ú¡C
A.1+2+3
B.1+2+5
C.2+3+4
D.3+4+5
E.1+4+5
 
(B) 3.ÁÂ¥ý¥Í¦~33·³¬O¤w±Bªoº£¤u¡Aªñ2¦~³vº¥¤£­@¬¡°Ê¡Aª¦¤G¼h¼Ó´N¦³©I§l§xÃø¡Aªñ¤E­Ó¤ë¯gª¬§ó¥[¼@¡A¦­¦~ªA§L§Ð®É§Y¦³¤ßŦÂø­µ¡A¦ý¯f¤H¨ÃµLºÝ§¤©Ê©I§l§xÃø©Î¸}¸~¡A²z¾ÇÀˬd¡G¨­°ª181 cm¡AÅé­« 77 ¤½¤ç¡A¦åÀ£130/80 mmHg¡A¥¿±`ÀVÀR¯ß²z¾ÇÀˬd¡A¯Ý³¡©I§l¥¿±`¡A¤ßŦ PMI¦b²Ä¤­¦Ø¶¡¡A¥ª¤¤Âê°©½u¥ª²¾¤@«ü¡AS1 ¡ô¡AS2 ¡õ¡AGr III/VI to and fro murmur over aortic area¡Ano radiation to neck¡AGr II/VI diastolic rumbling murmur over apex¡A¥¼¦³¨x¸~¡A¨ä¥LµL¤£¥¿±`¡C¶W­µªi¤ß¹Ï§e²{¥ª¤ß«Ç(µÎ±i¥½´Á¤j¤p/¦¬ÁY¥½´Á¤j¤p) 60/38 mm ¤Î¥ª¤ß«Ç®g¥X¤À¶q66%¡C¤ß¹q¹Ï ¡BX¥ú ¤Î¶W­µªi¤ß¹Ï ¦pªþ¹Ï ¡A¤U¦C¦óªÌ¥¿½T1.Left ventricular hypertrophy with systolic overloading¡C2.Left ventricular hypertrophy with diastolic overloading¡C3.Lung congestion¡C4.Acute anterior wall infarction¡C5.Hypertensive cardiovascular diseases¡C
A.1+2
B.2+3
C.3+4
D.4+5
E.1+5
 
(E) 4.¤U¦C¦³Ãö¥D°Ê¯ß佤¯U¯¶(aortic stenosis)ªº°O­z¬O¥¿½Tªº¡G1.¤Hªº¥D°Ê¯ß佤¯U¯¶ªº¯f²z¥Í²z¤ÏÀ³¬O¥ª¤ß«ÇÂX¤j¡C2.¥D°Ê¯ß佤¯U¯¶©Ò­Pªº¤ß¦Ù¯Ê®ñ¦h¦]«aª¬°Ê¯ßµ°ª¬µw¤Æ­P¤§¡C3.¬ù80%ªº¥D°Ê¯ß佤¯U¯¶µo¥Í¦b¨k©Ê¦Ñ¤H¡C4.¦b¥D°Ê¯ß佤¯U¯¶©Ò­Pªº¹B°Ê©Ê©ü³Ö(exertional syncope)³£¦]¤ßŦ·i¦å¶q¤Î±Æ¦å¶q´î¤Ö¦³¥H­P¤§¡C5.¥D°Ê¯ß佤¯U¯¶ªº¯gª¬¥i¨M©w¹w«á,¤ßŦ°IºÜ¬O³Ì¦hªº¦º¦]¡C
A.1+2
B.1+3
C.2+4
D.2+5
E.3+5
 
(B) 5.ªÎ«p©Ê¤ß¦Ù¯f(hypertrophic cardiomyopathy)¨ã¤U¦C½Ñ¦h¥¿½T¯SÂI¡G1.¦h¼ÆªÎ«p©Ê¤ß¦Ù¯f(75%)·|¦³¥ª¤ß«Ç¥X¤f¹Dªý¶ë(left ventricular outflow tract obstruction)¡C2.¥ª¤ß¦ÙªÎ«p¦nµo©ó¤ß«Ç¤¤¹j¡C3.Ö`¦º¦h¨£©ó¤¤¦Ñ¦~¤H¡C4.¥b¼ÆªÎ«p©Ê¤ß¦Ù¯f¯f¤H¦³®a±ÚÅã©Ê¿ò¶Ç¡C5.¾A·í¿ï¥Îdigitalis, diuretic, nitratesªvÀø¬O¥²­nªº¡C
A.1+3
B.2+4
C.1+5
D.2+5
E.3+5
 
(A) 6.¦³Ãö«aª¬°Ê¯ßµ°ª¬µw¤Æ¯g¤§µLª§½×ªº¦MÀI¦]¤l(risk factors)¦³(1).©â·Ï¡BªÎ­D¡BÃi°Ê(2).¦Ñ¦~¡B¤k©Ê¡B¿ò¶Ç(3).°ª¯×¦å¡B¯Ø®q¯Àªý§Ü(insulin resistance)¡B°ª¦åÀ£(4).Homocysteine¡BLipoprotein(a)¡BInfection(5).Vitamin B6, B12¤Î Folate
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(C) 7.¯f¤H¤»¤Q¤­·³¦³«æ©Ê¤ßµ±µh, ¤ß¹q¹Ï§e²{¨ãST¬q¤Wª@ªº¤U¾À¤ß¦Ù±ð¶ë¯g, ¨D¶E«æ¶E³¡®É¶Zµo¯f«á¤T¤p®É, ¦åÀ£ 86¢A58 mmHg, ¤ß¸õ 98/min, ¦¹®É±zªºªì¨BÃĪ«ªvÀøÀ³¦³¡G(1).Aspirin 100 mg¡C(2).iv Morphine 4mg¡C(3).iv Heparin 5000 u¡C(4).Captopril 6.25 mg¡C(5).iv Metoprolol 5mg¡C
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(A) 8.¦³Ãö·P¬V©Ê¤ß¤º½¤ª¢(infective endocarditis)¤§°O­z, ¥H¦óªÌ¬°¥¿½T¡H(1).³q±`§Ü¥Í¯ÀªvÀø¥k¤ß¤º½¤ª¢¤ñªvÀø¥ª¤ß¤º½¤ª¢¬°Ãø¡C(2).¤ß«Ç¤¤¹j¯Ê·l(VSD)ªºÂجÐ(vegetation)¦h¨£©ó¥k¤ß¯Ê·l½t(3).·P¬V©Ê¤ß¤º½¤ª¢¤§¶EÂ_¦³¿àÂجФ§µo²{¤Î¦å²G·P¬Vª«¤§°ö¾i(4).¦åºÞ¤§¦å®êªý¶ë¦h¨£©ó§Ü¥Í¯ÀªvÀø«á³Ìªì¼Æ¤Ñ(5).Åðµß©Ê¤ß¤º½¤ª¢¦]ÂجЦ¨ªø½wºC¦MÀI§C, ¥Hiv amphotericin B ªvÀø¬°©y
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(D) 9.¤U¦C佤©Ê¤ßŦ¯f(valvular heart disease)¿ï¾Ü¥~¬ì¤â³N¤§¨M©w¬O¥¿½T¡C(1).¤T¦y䳬Âꤣ¥þ(tricuspid regurgitation)³y¦¨¥k¤ß«Ç°IºÜ¡C(2).¤G¦y䳬Âꤣ¥þ(mitral regurgitation)¨Ö¦³©I§l§xÃø¡C(3).¤G¦y佤¯U¯¶(mitral stenosis)¤§mitral valve area¤p©ó1 cm2¡C(4).¥D°Ê¯ß佤³¬Âꤣ¥þ(aortic regurgitation)¤§¥ª¤ß«ÇµÎ±i¥½´Á¤j¤p(LVEDD)¤j©ó50 mm¡C(5).¥D°Ê¯ß佤¯U¯¶(aortic stenosis)¤§pressure gradient¤j©ó50 mmHg¡C
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(E) 10.¤ý¥ý¥Í58·³¦³¤W¯Ýµh«ùÄò¤@­Ó¤p®É, ¦ñ¦³¥þ¨­«_¦½, Áy¦â»a¥Õ, º¸«á¤S¦³¯kµhª½®g«á­I¡C¤D¨D¶E«æ¶E³B¡C¨D¶E®É¦åÀ£220/110 mmHg, ¤ß¸õ98/min, ¤ß¦y³¡¦³Gr. II Systolic murmur, ¥ª«á¯Ý³¡¦³Åo¿B©I§lÁn,¨ä¥L¥¿±`¡C­È¯ZÂå®vÃhºÃ«æ©Ê¥D°Ê¯ß­éÂ÷(acute aortic dissection),¤U¦C¦ó¶µ¬O¥¿½Tªº«æ¶E³B¸m?(1).À³¥ý¶}¥ßcontrast medium-enhanced CT½T©w¶EÂ_¡C(2).À³¥ýiv labetalol ¥H­°§C¦åÀ£¡C(3).À³·Ó·|¤ß¥~§@ºò«æsurgical repair¡C(4).À³¥ý¨Ï¥Îiv morphine 3 mg¤î¯k¡C(5).À³¥ý·|¶Eºë¯«¬ì§@¤ß²zªvÀø¡C
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(E) 11.¬ü°ê JNC-7 Report ªº°ª¦åÀ£¶EÀø«ü¤Þ (guideline) ³W©w¦³¡G¤U¦C¦óªÌ¬°¥¿½T(1).¦¬ÁYÀ£¤¶©ó 120-130 mmHg ©ÎµÎ±iÀ£¤¶©ó 80-89 mmHg ºÙ¬°°ª¦åÀ£«e´Á (Pre-hypertension) À³¶}©lÃĪ«ªvÀø¡C(2).¤j³¡¥÷°ª¦åÀ£¯f¤Hªº¥Ø¼Ð¦åÀ£À³¤p©ó140/90 mmHg¡F¦Ó¿}§¿¯f©ÎºC©ÊµÇŦ¯f¤HÀ³¤p©ó130/80 mmHg¡C(3).Angiotensin-converting enzyme inhibitors, calcium channel blockers ¬O°ª¦åÀ£¯f¤H¤§°_©lªvÀøªº­°¦åÀ£¾¯ ¡C(4).¦¬ÁY©Ê°ª¦åÀ£¦³¤ß¦åºÞ¯f¤§¦MÀI¶É¦V¡C(5).¶È¥Î Thiazide Ãþ¤§§Q§¿¾¯¤£¯à§@¬°°ª¦åÀ£¤§°_©lªvÀøÃĪ«¡C
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(C) 12.¤HÅé¥i¹º¤À¬° (1) ¥Ö½§(Integument)¡C (2)ÀY¡B²´¡B¦Õ¡B»ó¡B³ï(HEENT)¡C (3)©I§l(respiratory)¡C (4)¤ß¦åºÞ(cardiovascular)¡C (5)®ø¤Æ(gastrointestinal)¡C (6)ªc§¿¥Í´Þ(genitourinary)¡C (7)·s³¯¥NÁÂ/¤º¤Àªc(endocrine/metabolic)¡C (8)¦å²G(hematologic)¡C (9)¯«¸gºë¯«(neuropsychiatric)¡C (10)¦Ù¦×°©Àf(musculoskeletal)µ¥¨t²Î¡C¦bª½±µ¾É­P©I§l§xÃø¤§­ì¦]§@Ų§O¶EÂ_®É¡AÀ³¦Ò¼{¤§¨t²Î¬°?
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(B) 13.¤@¦W60·³¨k©Ê¡A¦]©I§l§xÃø¦bªù¶E¶E¹î«á¡A§@¤ß¹q¹Ï(¦p¹Ï¥Ü)¡C¨ä¤ß¹q¹Ï©Ò¨£¥i¥Ñ²z¾ÇÀˬd¹wª¾©Î±À´ú¡A¦³Ãö¨ä²z¥Ñ¤§¥H¤U±Ô­z¦óªÌ¤£¥¿½T?
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(B) 14.¥H¤U¦óºØ¥ð§J(shock)¥i¥Ñ¨ã°ªÄµÄ±©Ê¶EÂ_¡B³B¸m«á¡A¾É­P¥ß¬ñ¨£¼v¦åÀ£¦^¤É¤§®ÄªG(¦]¦¹¡A¦b¥ð§J¤§Å²§O¶EÂ_¤W¡A¤@©w¤£¯à¿ù¹L¦¹¶EÂ_)?
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(D) 15.¤@¦W60·³±w¦³¿}§¿¯f¤§¨k©Ê¡A¦]3­Ó¤ë¨Ó¦³¥ª¤p»L(calf)¶¡·²©Ê¶_¦æ¦Üªù¶E¨D¶E¡C¦¹¯f±wµL°ª¦åÀ£¯f¥v¡AÁ{§É¤WµL«aª¬°Ê¯ß¯e¯f¼x­Ô(¦p¯U¤ß¯g¡B¤ß¦Ù±ð¶ë)¡A¤ßŦ²z¾ÇÀˬd¥¿±`¡A¤â¸}·Å·x¦ÓµLµoÖæ²{¶H¡A¥½±é°Ê¯ß¥]¬AªÑ°Ê¯ß(femoral)¡BçA°Ê¯ß(popliteal)¡B¨¬­I°Ê¯ß(dorsalis pedis)¤Î«á×H°©°Ê¯ß(posterior tibialis)µ¥¯ß·i±j«×¥¿±`¡C¥H¤U¦óºØ²z¾ÇÀˬd¥i½T©w¦³·N¸q¤§¤UªÏ°Ê¯ß¯Ê¦å(arterial ischemia)?
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D.Elevation-dependency (¤WÁ|¡B¤U««) test
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(A) 16. ¤@¦W60·³±w¦³¿}§¿¯f¤§¨k©Ê¡A¨ã¦³¥ª¤ß«ÇµÎ±i©Ê°IºÜ(diastolicdysfunction)¤§¯f¥v¡A¦b¦~¸`®É§Ñ°OªA¥ÎÃĪ«¨Ã­¹¥ÎÄЭ¹ª««á¡Aµo¥ÍÄY­«©I§l§xÃø¦Ü«æ¶E«Ç¨D¶E¡C²z¾ÇÀˬdµo²{¯f¤H¥bºÝ§¤©I§l¡B·NÃÑ©|²M´·¡B¦åÀ£100/70 mmHg¡B¤ß³t²v100/min ³W«h¡B¤â¸}¦B§N¦Ó¦³»´·LµoÖæ²{¶H¦ýµL¯B¸~¡BÀVÀR¯ßÀ£¥¿±`¡B¤ßŦµLÂX¤j²{¶H¡B²Ä¤G¤ß­µ(P2)¤®¶i¡BµLÂø­µ¦ý¦³²Ä¥|¤ß­µ(S4)¡BªÍ³¡¦³Äjº©©ÊÅo­µ¡C¤ß¹q¹ÏÅã¥ÜÄu©Ð«ß(sinus rhythm)¥B»P¥ý«e¤§¤ß¹q¹Ï¤ñ¸ûµL·sÅܤơA¯Ý³¡X¥úµo²{¦³«æ©ÊªÍ¤ô¸~(pulmonary edema)¤§©Ò¨£¡A¦ý¤ßŦ¤j¤p¬°¥¿±`¡C¦¹¯f±w¸gÀR¯ßª`®gdopamine¤ÎfurosemideªvÀø¡AÀH¤§±Æ§¿700 cc«á©I§l§xÃø©úÅã§ïµ½¡A¦ý¯f¤H¤U§É®É·PıÀY·w¡C¤U¦C¦³Ãö¤§±Ô­z¡A¦óªÌ¬°«D?
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C.¤Ï¤§¡A¨Ç·L§Q§¿700 cc«áªÍ¥R¦å§ïµ½¡A¬Æ¦Ü¦]¥ª¤ß«Ç«e­t²ü¹L«×¤U­°¦Ó¾É­P°_§¤©ÊÀY·w¡C
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(E) 17.¦b¤U¦C¯fÅܾɭP¥ª¤ß°IºÜ®É¡A¯Ý³¡X¥úÀˬdÅã¥Ü¦³ªÍ¥R¦å(congested lungs)¤§²§±`©Ò¨£¡A¦ý¤ßŦ¤j¤p¬°¥¿±`¡C¦óªÌ¬°«D?
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(A) 18. ¤@¦W¥H©¹°·±d¤§40·³¨k©Ê¡A³Ìªñ¤u§@À£¤O¤j±`ºò±i¦³¤ß±ª²{¶H¡A¦]¦Ó±µ¨ü°·ÀË¡CÀˬd®É¦åÀ£¡B¯Ý³¡X¥ú¡B¦å¿}¤Î¦å¯×Àˬd¥¿±`¡A¦ý¦]¤ß¹q¹Ï²§±`¦Üªù¶E¨D¶E¡A¦åÀ£¡B¯ß·i¡B¤ßŦ²z¾ÇÀˬd¥¿±`¡C¥H¤U(1)-(4)¤§±Ô­z¤¤¡A¤£¥¿½TªÌ¬°¦ó?(1).¦¹¨üÀˤH³Ìªñ¤§¤ß±ª©w¬°°}µo©Ê¤W¤ß«ÇÀW¯ß(paroxysmal supraventricular tachycardia)©Ò¾É­P¡C(2).¦¹¨üÀˤH¥H©¹¦³: µL¯gª¬©Ê¤U¾À¤ß¦Ù±ð¶ë(silent inferior myocardial infarction)¡C(3).¦¹¨üÀˤH¦³¥k¤ß«ÇªÎ¤j¡C(4).·í¦¹¨üÀˤH±N¨Ó¦p°ªµo¿N¦Ó¾É­PÄu©Ð©Ê¤ß·i¹L³t(sinus tachycardia)«æ¶E¨D¶E®É¡A¨ä¤ß¹q¹Ï¥i¯à³Q»~»{¬°¦³¤ß«Ç©Ê¤ß·i¹L³t(ventricular tachycardia)¡C
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(D) 19.¤@¦ì66·³¤k©Ê¦]¸¡µh©ó«æ¶E¨D¶E¡A¤ß¹q¹Ï¦p¹Ï©Ò¥Ü¡C¤U¦C±Ô­z¡A¦óªÌ¬°«D?
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A.Atrial reentrant tachycardia
B.Atrial flutter
C.Atrial fibrillation
D.AV nodal reentrant tachycardia ¤ÎAV reentrant tachycardia (WPW syndrome)
E.Idiopathic ventricular tachycardia
 
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A.1+2
B.2+3
C.2+3+4
D.1+2+4
E.1+2+3+4
 


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