九十七年度內科專科醫師考試筆試題 -- 免疫科

(D) 1.一位36歲的女性最近四個月來每天在傍晚之後,在兩手、兩腿及腹部會有蕁麻疹樣的皮疹出現,奇癢難忍。到門診求診經服用抗組織胺之後只有短暫效果。請問增加下列何種藥物,對於控制病情最有幫忙?
A.Topical glucocorticoid ointment application
B.Methylprednisolone pulse therapy
C.Cyclophosphamide pulse therapy
D.Hydroxychloroquine
E.Sedatives
 
(B) 2.一位19歲的男性被虎頭蜂叮螯之後,發生昏眩、冒冷汗及呼吸困難。經送急診之後,請問下列的何種處置應最為優先?
A.High-dose glucocorticoid (1 mg/kg/day) injection
B.1:1000 x diluted epinephrine subcutaneous injection
C.Check arterial blood gas (ABG)
D.Anti-histamine intramuscular injection
E.Endotracheal intubation
 
(A) 3.46歲的王先生為慢性B型肝炎帶原者。最近兩個月來有左手腕關節及右手肘關節腫痛。抽血檢查發現ANA 1:160 speckled pattern,RF 33.7 IU/ml (normal < 20),ESR 46 mm/1h,97 mm/2h,CRP 1.48 mg/ml,anti-CCP 84.8 IU/ml (normal < 10)。請問患者的最可能診斷為何?
A.Rheumatoid arthritis
B.HBV-related arthropathy
C.Undifferentiated arthritis
D.Ankylosing spondylitis
E.Osteoarthritis
 
(E) 4.在下列的"疾病-標幟抗體"的配對中,何者最正確?
A.Acute rheumatic fever - anti-IgG antibodies
B.Systemic sclerosis - anti-centromere antibodies
C.Vasculitis syndrome - anti-Klebsiella cell wall antibodies
D.Sjogren's syndrome - anti-Jo-1 antibodies
E.Mixed connective tissue disaease - anti-U1RNP antibodies
 
(B) 5.一位47歲女性到院求診的主訴為近兩年來兩側手指在冬天時會變白及變紫。近三個月來兩手背皮膚慢慢變硬,臉部的運動也逐漸僵硬。吞嚥時偶會嗆到。血清學檢查發現ANA 1:160 speckled + centromere pattern,anti-SSA(-),anti-SSB(-),RF(-),anti-Scl-70 576 IU/ml,anti-CENP(-),p-ANCA(-),及c-ANCA(-)。肺功能顯示輕~中度限制性呼吸異常,而DLCO顯現中等度擴散功能異常。請問投予長期下列何種藥物最有幫助?
A.Methotrexate
B.D-penicillamine
C.Cyclophosphamide pulse therapy
D.Angiotensin II receptor blocker
E.Anti-endothelin receptor antagonist
 
(A) 6.一位64歲的婦人最近半年來有明顯的眼乾及口乾的症狀,但是血糖值正常。來院檢查的結果如下:ANA 1:640 speckled pattern,anti-SSA 648IU/ml (normal<120),anti-SSB 312 IU/ml(normal<120),RF 311 IU/ml。被診斷為"Sjogren's syndrome"。為了進一步評估其臨床症狀,請問下列的檢查何者與病人診斷最符合?
A.Schirmer's test可以評估淚腺的功能
B.Rose-Bengal test可以評估唾液腺的功能
C.Sialoscintigraphy用來評估甲狀腺的功能
D.Serum IgG,IgM,IgA的濃度可以直接反映患者的免疫功能
E.Nailfold capillaroscopic examination可以直接反映患者pulmonary fibrosis的程度
 
(E) 7.一位47歲的女性患者5年前曾有一次虹彩炎(Iritis)發生,及有一段時期早上起床時會有下背疼痛,後來便逐漸好轉。最近8個月來頸部及兩側肩關節經常酸痛而求診。檢查結果顯示ANA(-),RF(-),CRP 1.74,HLA-B27(+)。另外,家族史中顯示父親有亦有類似情況,而弟弟為乾癬患者。本患者的骨盆的X光照相如圖 ,請問這位患者的最可能的診斷為何?
A.Rheumatoid arthritis
B.Undifferentiated spondyloarthropathy
C.Systemic lupus erythematosus
D.Osteoarthritis
E.Ankylosing spondylitis
 
(D) 8.血管炎(Vasculitis)的診斷有時相當困難。請問出現下列的哪些症候組合時,最有可能是血管炎的表現? (1) ANA(+) (2) systemic involvement (3) polyarthritis (4) palpable purpura (5) microscopic hematuria (6) chronic eczematous skin lesion (7) mononeuritis multiplex (8) body weight loss (9) pulmonary interstitial infiltration
A.1+2+3+4
B.2+3+6+8
C.1+5+6+9
D.4+5+7+9
E.1+3+7+8
 
(A) 9.實驗室的檢查可以作為診斷風濕性疾病的輔助手段之ㄧ。請問下列的哪些檢查的組合,最有助於紅斑性狼瘡的診斷?(1) complete blood routine (2) ESR (3) CRP (4) C3/C4 levels (5) ANA (6) IgMRF (7) anti-CCP (8) ANCA (9) anti-dsDNA (10) immunoglobulin levels (11) anti-microsomal antibodies
A.1+4+5+9
B.3+6+7+10
C.1+2+8+11
D.6+7+9+10
E.2+3+5+11
 
(C) 10.1987年美國風濕病學院所定診斷rheumatoid arthritis的7個項目中,請選出正確的4項:(1) 手及腕部的X-光照片顯示有osteophyte的存在 (2) 罹患的7個特定關節區(joint area)是包括手部的proximal interphalangeal (PIP)及metacarpophalangeal (MCP),wrist,shoulder,hip,knee及足部的metatarsophalangeal (MTP) joints (3)RF(+) (4) leukocytosis with thrombocytosis (5) anti-CCP antibodies(+) (6) ESR/CRP值的上升 ( 7) morning stiffness ≧30 min (8) symmetric arthritis (9) arthritis of hands and wrist joints (10) subcutaneous nodules
A.1+2+3+8
B.2+3+5+9
C.3+8+9+10
D.2+4+6+7
E.4+5+6+9
 


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