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105年 - 105 內科專科醫師考試筆試題：腎臟科#102032

科目：腎臟科 | 年份：105年 | 選擇題數：22 | 申論題數：0

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所屬科目：腎臟科

選擇題 (22)

1. 54歲肥胖男子(BMI 27.6)，因高血壓一直控制不佳而被轉診，其降壓藥物開始有Verapamil、Metoprolol、Clonidine，後來調整成Amlodipine、Atenolol、Valsartan、Doxazosin、Minoxidil五種，但是血壓仍然在160-180/100-110 mmHg。他常因頭痛與關節酸疼服用Ibuprofen，最近檢測血清肌酸酐為2.9mg/dL；另外有呼吸中止症候群，因配戴儀器睡覺不舒服，沒有每天接受continuous positive airway pressure (CPAP)治療。 為了能將血壓好好控制，請問底下處置哪些為正確？ 1. 應該改用Selective COX2 inhibitor，對血壓較無影響。 2. 應該安排24小時動態血壓監測(24 hour ambulatory blood pressure monitor) 的檢查。 3. 應該加上利尿劑之使用以及篩檢其他次發性高血壓。 4. 應該減重及強調每天使用CPAP治療。 5. 應該推薦做腎動脈交感神經燒灼術治療。 (A) 1+2+3 (B) 1+3+4 (C) 1+3+5 (D) 2+3+4 (E) 1+2+3+4
2. 63歲男性病人兩天前接受膀胱鏡檢查，逐漸出現畏寒發燒、解尿不易、解尿疼痛、頻尿、會陰處稍微不適；體溫攝氏38.3度、其他生命現象穩定，Costophrenic angle無敲擊痛、尿道口無分泌物；尿液檢查有10 WBC/HPF、Nitrite 1+, Leukocyte esterase 1+；抽血檢查腎功能正常，PSA 升高至25ng/ml。 請問底下哪些敘述是正確的？ 1.應該要做尿液與血液細菌培養 2. 因為尿液Nitrite呈陽性，極可能是Pseudomonas感染 3. 應該安排腎臟膀胱攝護腺超音波檢查 4..可給予口服Fluoroquinolone二至四週 5. 可給予口服Nitrofuratoin二至四週 (A) 1+2+4 (B) 1+3+4 (C) 2+3+4 (D) 1+3+5 (E) 2+3+5
3. 58歲男性病人有高血壓、高血脂、慢性腎臟病、痛風(近半年發作三次，最後一次為三周前，在手指、腳趾、手肘、耳朵等多處關節有Subcutaneous tophi)。目前抽血檢查血清肌酸酐2.1 mg/dL(eGFR 33)；尿酸 9 mg/dL。其目前服用藥物有Thiazide、Losartan、Amlodipine、Fenofibrate、 low dose aspirin。 請問下列哪些處置為恰當？ 1.開始使用Allopurinol或Febuxostat，但須降低劑量。 2.停用Thiazide，因為會加尿酸而且增加Allopurinol的毒性。 3. Losartan、Amlodopine、 Low dose aspirin 均會促進尿酸排泄。 4.已非急性痛風期，不必再使用Colchicine。 5.此病人降低尿酸之預期目標為6 mg/dL以下。 (A) 1+2+3 (B) 2+3+5 (C) 1+2+5 (D) 1+3+5 (E) 1+4+5

4. 62歲女姓，過去無高血壓或糖尿病，近五年雙手手指碰冷水會變紅紫，最近四個月逐漸出現以下症狀：面孔與手指浮腫、吞嚥不順、說話遲緩、下肢腫脹、血壓變高、呼吸急促、呼吸困難、端坐呼吸。BP160/83 mmHg, Urine protein 3+, RBC 40-50/HPF;Hb 7.4 gm/dL,Alb 2.8 gm/dL,Cre 2.8 mg/dL(半年前1.2 mg/dL) 。( 如圖示) 請問下列何者為正確？ (A) 馬上住院並開始類固醇的治療。 (B) 若在發病前給予ACE inhibitor，即可有效地預防此病之發作。 (C) 若病人沒有出現高血壓(即Normotensive)，其病情與預後會較好。 (D) 若病人之autoantibody against topoisomerase I (Scl70)呈陽性，其預後較好。 (E) 若兩年後仍無法脫離透析治療，可建議病人接受腎臟移植，因為其存活率還好且很少復發。\"616031ea6ec77.jpg\"
5. 追蹤糖尿病病人血糖控制情形的糖化血色素(Glycosylated hemoglobin, HbA1C)，請問有哪些狀況會假性增高(fasle high)? 1. Hemolytic anemia 2. Iron dficiency anemia. 3. High dose Vitamin A or C 4. Chronic kidney disease 5. Chronic liver dsease. (A) 1+2 (B) 1+3 (C) 2+4 (D) 3+5 (E) 4+5
6. 關於攝護腺特定抗原(Prostate specific antigen,PSA)之測量與篩檢，底下何者為正確？ 1. PSA之篩檢具極佳之敏感度(Sensitivity)與特異性(Specificity)。 2. PSA之血中濃度跟攝護腺癌之發生機率及預後無明顯相關。 3. PSA之篩檢建議只在年齡55到69歲的男性，才有利多於弊。 4. PSA之篩檢建議只在預估壽命有超過15年的男性才需考慮。 5. PSA之篩檢若包括測量free PSA，可增加測得攝護腺癌的機率。 (A) 1+2 (B) 2+5 (C) 1+2+3 (D) 2+3+4 (E) 3+4+5
7. 當紫斑症Purpura 出現時，其重要的鑑別診斷為是否Palpable， 請問底下那些腎臟疾病出現的purpura是為Palpable? 1. Uremia 2. Thrombotic thrombocytopenic purpura 3. Henoch- Schonlein Purpura 4. Waldenstrom's hypergammaglobulinemic purpura 5. Polyarteritis nodosa (A) 1+3 (B) 2+4 (C) 2+3+4 (D) 1+3+5 (E) 3+5
8. 65歲女性因腎病症候群(膜性腎病變)過去曾接受類固醇與利尿劑已有五年時間，但目前為緩解狀況，類固醇仍維持(Prednisolone 10mg QD)，請問關於病人骨質疏鬆方面，底下處置那些視為恰當？ 1. 類固醇劑量很低不會有影響，不必考慮停用。 2. 應該確定每天有口服足量的鈣片與維他命D。 3. 可考慮給予Bisphosphonate來預防骨折。 4. 應該不用每年安排檢測骨密度(DXA)之檢查 5. 如有骨質疏鬆，可考慮施打合成的副甲狀腺素。 (A) 1+2 (B) 1+2+3 (C) 1+2+4 (D) 1+4+5 (E) 2+3+5
9. 30歲男性初次參加馬拉松賽跑後不支倒地，肌肉痠疼且尿液呈棕紅色，送至急診初步檢查量得體溫為38.8度(攝氏)，血壓正常，尿液試紙檢查有潛血2+但離心沉渣無紅血球，肌酸酐1.3mg/dL，CPK 13000u/L 請問底下敘述何者為正確？ 1. 像熱中暑，因此發生急性腎衰竭機率大。 2.必須依靠血液或尿液myoglobin的定量檢查才可確定是橫紋肌溶解症。 3.其上述尿液試紙檢查結果代表可能會發生急性腎衰竭。 4.應該積極補充大量體液，維持尿液3ml/kg/hr，直到尿液試紙潛血反應呈陰性。 5.如果尿液pH<6.5，一定要點滴加上Bicarbonate鹼化尿液。 (A) 1+2+3 (B) 1+3+4 (C) 2+4+5 (D) 3+4+5 (E) 1+4+5
10. Which patient may have the highest risk and progression of CKD ? (A) CKD stage 1, with normal albuminuria (B) CKD stage 3b, with normal albuminuria (C) CKD stage 2, with severely increased albuminuria (D) CKD stage 3a, with moderately increased albuminuria (E) CKD stage 3, no matter the status of albuminuria, will have similar risk of CKD progression
11. Systemic diseases may induce thrombotic microangiopathy in the kidney, with the pathological picture of secondary focal segmental glomerulosclerosis. Which does not belong to this category ? (A) hemolytic-uremic syndrome (HUS) (B) Hepatitis B virus infection (C) Malignant hypertension (D) Antiphospholipid syndrome (E) Radiation nephropathy after bone marrow transplantation
12. A 38-year-old woman who had been diagnosed as membranous nephropathy with heavy proteinuria (4.5 g/day). One day she presented with flank pain, tenderness, hematuria, and rapid decline in renal function. Which is the most likely diagnosis ? (A) Renal stone with urinary tract infection (B) Renal vein thrombosis (C) Renal artery stenosis (D) Malignant hypertension (E) Thrombotic microangiopathy
13. Several nutrients have been implicated to increase risk for nephrolithiasis formation. Except ? (A) Higher intake of animal protein (B) Higher intake of potassium-rich or magnesium-rich food (C) Higher sodium intake (D) Vitamin C supplement is associated with an increased risk of calcium oxalate stone (E) Higher consumption of sugar-sweetened carbonated beverage
14. A 48 y/o male was found to develop acute renal failure after 7 days of drug therapy. His clinical presentation were: fever, rash, peripheral eosinophilia, and oliguric renal failure, but without proteinuria. Which statement is correct? 1.A possible etiology of acute interstitial nephritis (AIN) 2.His manifestation is compatible with nonsteroidal anti-inflammatory drug (NSAID)-induced AIN 3.Peripheral blood eosinophilia is common in most of AIN patients 4.Urinary eosinophils are sensitive and specific for diagnosis of AIN, therefore, this testing is highly recommended 5.Renal biopsy is generally not required for diagnosis of AIN (A) 1+3+4+5 (B) 1+5 (C) 1+3+4 (D) 1+2 (E) 1+2+3+4+5
15. Which statement regarding Lithium-associated nephropathy is not correct ? (A) Most of the patients presented as oliguric acute renal failure (B) Prolonged (>10-20 years) lithium use, or those experienced repeated episodes of toxic lithium levels, may develop chronic tubulointerstitial nephritis (C) The most prudent approach is to monitor lithium levels frequently and adjust dosing to avoid toxic levels (D) In patients with significant proteinuria, ACEI or ARB treatment should be helpful (E) typical findings on renal biopsy are interstitial fibrosis and tubular atrophy
16. Which statement regarding mineral metabolism in CKD is correct? 1.increased production of parathyroid hormone 2.reduced production of fibroblast growth factor-23 (FGF-23) 3.increased renal excretion of phosphate 4.reduced produce of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] 5.reduction in serum calcium (A) 1+3+4+5 (B) 1+2+4 (C) 1+2+3+4 (D) 1+2+4+5 (E) 1+4+5
17. Primary glomerular diseases with reduced complement levels is: (A) Cryoglobulinemia (B) Minimal-change disease (C) IgA nephropathy (D) focal segmental glomerular sclerosis (E) Wegener's granulomatosis
18. Which test has the highest sensitivity of screening renovascular hypertension ? (A) Duplex ultrasonography (B) Computed tomography angiography (C) Captopril renogram (D) Magnetic resonance angiography (MRA) (E) Captopril plus diuretics renogram
19. For diagnosis of acute renal failure, which urinary indices indicating prerenal azotemia rather than acute tubular necrosis or obstruction ? (A) Urine Na > 40 mEq/L (B) Urine osmolarity < 400 (C) Urine/plasma creatinine ratio < 20 (D) Renal failure index < 1 (E) FENa > 2%
20. A 52-year-old man with a 20-year history of cigarette smoking is admitted to the hospital because of cough and weakness. On admission, his serum electrolyte levels are: serum [Na] 112 mEq/L; [K] 4.5 mEq/L; [Cl] 80 mEq/L; and HCO3-, 26 mEq/L. The BUN was 8 mg/dL , serum creatinine 0.8 mg/dL and serum uric acid 3.0 mg/dL. These data are most consistent with which of the following? (A) SIADH (syndrome of inappropriate antidiuretic hormone secretion) (B) Congestive heart failure (C) Cirrhosis and ascites (D) Severe salt and water depletion (E) Adrenal insufficiency
21. A 28 y/o young male visited your outpatient clinic with an elevated blood pressure of 148/100 mmHg. He denies taking any medications, but has a family history of hypertension. His laboratory values were: [Na] 140 mEq/L, [K] 3.1 mEq/L, [Cl] 98 mEq/L, BUN 25 mg/dL, Creatinine 0.9 mg/dL, Glucose: 85 mg/dL. The arterial blood gas (ABG) test reveals: Arterial pH: 7.48, PCO2: 46 mm Hg, HCO3-: 34 mEq/L. What is the most appropriate characterization of his acid-base disorder? (A) Metabolic alkalosis (B) Metabolic alkalosis and respiratory acidosis (C) Respiratory alkalosis and metabolic acidosis (D) Metabolic alkalosis and respiratory alkalosis (E) Respiratory alkalosis
22. 相較於血液透析(HD, hemodialysis)，有關腹膜透析(PD, peritoneal dialysis)的敘述與長期合併症，何者不正確? (A) PD病人使用高糖透析液是為了要達到透析清除尿毒素(uremic toxin)的效果 (B) PD病人容易出現hypertriglyceridemia，是因為使用高糖透析液 (C) 相較於血液透析(HD)，腹膜透析(PD)病人較容易發生腹膜炎(peritonitis) (D) 相較於血液透析(HD)，腹膜透析(PD)病人每日蛋白質流失量較高 (E) 相較於腹膜透析(PD)，血液透析(HD)病人較出現透析中低血壓

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