54. 不適合(simultaneous bilateral total knee arthroplasty [SBTKA]) 者，下列何者為非？
(A) Age ≥70 years
(B) ASA class III
(C) Active ischemic heart disease (positive stress test).
(D) Poor ventricular function (LVEF ＜40%)
(E) Oxygen-dependent pulmonary disease

50. 有關骨科手術麻醉，下列何者為非？ (A) Use of regional anesthesia in the patient with a recognized difficult airway can notsolve the problem of the difficult airway. (B) Regional anesthesia may reduce the incidence of major perioperative complications with certain surgical procedures. (C) Regional anesthetic techniques provide superior pain relief after orthopedic surgery. (D) Peripheral nerve blocks employing long-acting anesthetics or catheters provide both excellent intraoperative anesthesia and superior postoperative analgesia. (E) Regional analgesia can not block the progression of severe acute postoperative pain into a chronic pain syndrome.

51. 一位80歲病人平時有接受口服抗凝固劑(warfarin)治療，目前因為右側股骨頭骨折要開刀。關於區域麻醉的部 分，下列敘述何者為非？ (A) The anticoagulant therapy must be stopped (ideally 4 to 5 days before the planned procedure) and the INR must be normalized before initiation of neuraxial block (B) In patients receiving low-dose warfarin therapy during epidural analgesia, their INRshould be monitored on a daily basis (C) Neurologic testing of sensory and motor function should be performed routinely during epidural analgesia for patients on warfarin therapy (D) As thromboprophylaxis with warfarin is initiated, neuraxial catheters can be removed when the INR is 2

52. 有關Fat Embolism Syndrome (FES)，下列何者為非？ (A) The embolization of fat can be detected in almost all patients who sustain a pelvic or femoral fracture, but the incidence of FES is less than 1%. (B) The manifestation of FES can be gradual, developing over 12 to 72 hours, or fulminant, leading to acute respiratory distress and cardiac arrest. (C) A petechial rash is pathognomonic of FES, with the rash usually present on the conjunctiva, oral mucosa, and skin folds of the neck and axillae. (D) Patients at risk for developing FES should be monitored with pulse oximetry, and mechanical ventilation should be instituted before respiratory failure. (E) 10% of patients with FES may require mechanical ventilation, and the symptoms resolve within 2 to 4 days in most of these patients.

53. 有關Rheumatoid Arthritis 病人，下列何者為非？ (A) Anterior subluxation of C1 on C2 (atlantoaxial subluxation) may occur in 40% of patients with RA, with symptoms of progressive neck pain and headaches. (B) Risk also increases for cricoarytenoid dislocation with traumatic endotracheal intubations. (C) Rheumatoid Arthritis patients are rarely affected with acute pericarditis. (D) Flexion of the head in the presence of atlantoaxial instability could result in the displacement of the odontoid process into the cervical spine and medulla and compression of the vertebral arteries. (E) Overlapping connective tissue syndromes such as Sjögren’s syndrome and Felty syndrome also occur.

55. 有關Interscalene Block (ISB) 下列何者為非？ (A) The major acute complications associated with ISB are respiratory depression, seizures and cardiac arrest, pneumothorax, epidural and spinal anesthesia. (B) The ipsilateral phrenic nerve is blocked in some patients undergoing ISB, resulting in hemidiaphragmatic paresis. (C) Because hemidiaphragmatic paresis may result in a 25% reduction in pulmonary function, patients with severe respiratory disease may not tolerate an ISB without the addition of mechanical ventilation. (D) An ISB would be contraindicated in patients after pneumonectomy on the contralateral side and for bilateral operative procedures. (E) The supraclavicular approach to the brachial plexus with ultrasound guidance may pro- vide effective shoulder anesthesia without complete ipsilateral paresis of the phrenic nerve.

56. 在高麻醉風險病患，施行開胸手術後，最能有效降低respiratory complications的止痛方式為： (A) On-demand parenteral opioids (B) 合併使用 antiinflammatories and opioids (C) Intercostal nerves blockade (D) Paravertebral blocks (E) Epidural techniques

57. 有關 hypoxic pulmonary vasoconstriction (HPV)，下列何者錯誤？ (A) Alveolar oxygen tension (PAO2)降低而刺激 precapillary vasoconstriction，可造成流往 nonventilated lung 血量減少 達 50% (B) HPV 的作用機轉牽涉到 nitric oxide and/or cyclooxygenase synthesis inhibition (C) 與 mixed venous PO2 (PVo2)無關 (D) Vasodilators (nitroglycerin, nitroprusside)可緩解 HPV 作用 (E) Thoracic epidural sympathetic blockade 對 HPV 作用影響不大

58. 在 video-assisted thoracoscopic surgery (VATS) 中，已 one-lung ventilation (OLV) 約半小時後，發生 gradual desaturationwith SpO2 90%，下列處置何者錯誤？ (A) Ensure that FiO2 is 1.0, cardiac output is optimal (B) Apply PEEP 5 cm H2O to ventilated lung, CPAP 1-2 cm H2O to nonventilated lung (C) 不可用 recruitment maneuver to ventilated lung 來改善可能的肺擴張不全，它會造成 transient hypotension and further fall in PaO2 (D) 不需要立即要求暫停手術，恢復 two-lung ventilation (E) Use mechanical restriction of blood flow to nonventilated lung

59. 肺癌病患將接受肺組織切除手術，下列何者不是必要的開胸手術前肺功能評估檢查(所謂的 the three-legged stool)？ (A) Ventilation-perfusion scintigraphy: 用 V/Q lung scanning 來回推被切除肺組織是否具有功能性 (B) Respiratory mechanics: 其中 the predicted postoperative FEV1% (ppoFEV1%) 最能評估 the risk of major respiratory complications (C) Lung parenchymal function: The diffusing capacity for carbon monoxide is most useful test of gas exchange capacity (D) Cardiopulmonary interaction: The maximal oxygen consumption (VO2max) is the most useful predictor of postthoracotomy outcome

60. 麻醉 (anesthesia) 與意識 (consciousness) 及記憶 (memory) 的關係，下列何者錯誤？ (A) Conscious is characterized by wakefulness (所謂 being arousable) and awareness (所謂 subjective experience) (B) Memory for new information initiates by learning, then processes by long-term potentiation, synaptic tagging, consolidation, and reconsolidation. (C) Effects on the hippocampus, amygdala and prefrontal cortex may account for anesthetic-induced amnesia (D) Intraoperative awareness is an implicit episodic (unconscious) recall of surgical event (E) Propofol-induced unconsciousness in humans has been showed by a functional disconnection of association of cortex and subcortical structures