54. 患者因上腹痛反射至背部，合併噁心、嘔吐至急診，血液檢查amylase和lipase值均有3倍以上的增加，下 列何者不屬於判斷此病嚴重度的BISAP score？
(A) BUN＞25mg/dL。
(B) Impaired mental status。
(C) SIRS:2 ≧ of 4 present。
(D) Amylase＞2000 IU/L。
(E) Pleural effusion。

51. 患者因看牙醫發現於嘴唇、口腔有深棕色色素沈積，而轉診消化內科，經上、下消化道內視鏡檢查，發現 於胃及大腸有息肉，有關此病症的敘述何者為非？ (A) 息肉病理為hamartoma。 (B) 比起familial adenomatous polyposis，此種息肉轉成惡性機會較低。 (C) 與卵巢腫瘤發生有關。 (D) 與胰臟腫瘤發生有關。 (E) 與口腔腫瘤發生有關。

52. 有關大腸憩室症(diverticulosis)的敘述，何者為非？ (A) 通常在乙狀結腸(sigmoid colon)，但在亞洲族群，有70%發生在右側結腸。 (B) 是60歲以上病患發生下消化道出血最常見旳原因。 (C) aspirin及NSAID不會增加此類患者下消化道出血的風險。 (D) 以腹痛、發燒、白血球增加為表現的憩室炎可以先用抗生素治療。 (E) 憩室炎可進展成穿孔及腹膜炎。

53. 患者因腹痛、噁心、嘔吐及發燒到急診，腹部電腦斷層檢查如圖，按壓此病患左下腹時造成右下腹明顯疼痛，此現象稱為? (A) Rovsing’s sign。 (B) Obturator sign。 (C) Iliopsoas sign。 (D) Murphy’s sign。 (E) Cullen’s sign。  

55. Statement on management strategy for patients with autosomal dominant polycystic kidney disease (ADPKD), which is incorrect: (A) Dietary salt restriction may be beneficial in the management of ADPKD。 (B) Angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are the first-line antihypertensive drugs in ADPKD。 (C) Nonsteroidal anti-inflammatory drugs (NSAIDs) is more effective and safe than acetaminophen or tramadol for cystic pain relief in ADPKD patients。 (D) Oral tolvaptan can slow the increase in total kidney volume and the decline in kidney function of ADPKD patients。 (E) ADPKD patients can be a recipient for renal transplantation。

56. A 54 y/o diabetic female patient with 4 days of fever, respiratory symptoms and dyspnea. At emergency service, physical examination revealed postural hypotension, tachycardia, and Kussmaul respiration. Laboratory tests were: blood glucose level of 385 mg/dL. The arterial pH is 7.35, pCO₂ is 22 mm Hg, pO286 mmHg, 14 mEq/L. Serum electrolyte values were: Na 130 meq/L； K 5.1 meq/L； Cl 96 meq/L； Chest x-ray film indicated consolidation of bilateral lower lobe. Which of the following statements is most likely to be true? (1)The patient has respiratory acidosis, possibly related to pneumonia (2)The patient has metabolic acidosis, possibly related to diabetes (3)The patient has respiratory alkalosis, possibly related to pneumonia (4)The anion gap is still within normal range (5)Be cautious with hyperphospatemia during combined insulin and glucose therapy  (A) (1)+(2)+(5)。 (B) (1)+(2)+(4)+(5)。 (C) (2)+(3)+(5)。 (D) (2)+(3)。 (E) (2)+(3)+(4)。

57. A middle aged woman was referred to renal clinic for evaluation of her renal disorder. She had intermittent pre-tibial swelling for almost 3 months. She has mild hypertension, but no diabetes. Neither viral hepatitis B nor C history. Laboratory tests were: albumin 3.1 g/dL, creatinine 1.7 mg/dL, Both serum complement levels (C3 and C4) are low, with a particularly depressed C4 compared with C3. Which of the following should be considered ? (A) Cryoglobulinemia。 (B) Post-streptococcal glomerulonephritis。 (C) Membranoproliferative glomerulonephritis。 (D) Lupus nephritis, stage III or V。 (E) Infectious endocarditis or shunt nephritis。

58. Struvite stones occurs in patients of repeated urinary tract infections (UTI) from bacteria that produce the enzyme urease, including both gram-positive and gram-negative species. Which is the least possible micropathogen causing struvite stone and repeated UTI? (A) Klebsiella spp。 (B) Escherichia coli。 (C) Mycoplasma spp。 (D) Staphylococcus epidermidis。 (E) Proteus。

59. Which are correct statements regarding hyperuricemia and related nephropathy? (1)The renal tubular transporters responsible for determining how much of the filtered uric acid is actually excreted are located in the distal nephron (2)Renal clearance of uric acid can be inhibited by the angiotensin-converting-enzyme inhibitors or by β-Blockers. (3)Initiation of colchicine can induce acute flares of gout (4)Initiation of allopurinol or febuxostat can induce acute flares of gout (5)Routine use of allopurinol (100-300 mg/day) in patients with stage 3-4 CKD can slow kidney disease progression  (A) (1)+(2)+(4)+(5)。 (B) (1)+(4)+(5)。 (C) (2)+(3)。 (D) (2)+(4)。 (E) (2)+(4)+(5)。

60. A 26-year-old girl of type I diabetes had poor appetite and body weight loss for 3 kg (6%) in recent one month. After admission, she received partial parenteral nutrition due to anorexia and poor oral intake. Hypophosphatemia (0.8 mg/dL) was notcied on the third day of admission . The most likely mechanism for her acute hypophosphatemia is:  (A) Acute stage of diabetic ketoacidosis。 (B) Hungry bone syndrome。 (C) Primary hypoparathyroidism。 (D) Renal phosphate wasting。 (E) Shift of phosphorus into intracellular stores。

61. A 50-year-old male visited outpatient clinic due to difficult-to-control hypertension. After initial work up, hypokalemic hypertensive disorder was impressed, Further laboratory evaluation of adrenal hormones including plasma renin, aldosterone, cortisol, and androgen levels were arranged to distinguish among specific diagnoses. The results are: high renin level, high aldosterone level, an aldosterone-to-renin ratio of 10 : 1 ； and a normal serum cortisol level Which is the most possible diagnosis? (A) ACTH-secreting tumor。 (B) Bartter syndrome。 (C) Liddle syndrome。 (D) Primary hyperaldosteronism。 (E) Unilateral renal artery stenosis。

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