65. 一位60歲男性高血壓肥胖患者，近幾個月血壓升高以4種降壓劑控制，血壓為166/92 mm Hg。病患無家 族高血壓病史，一年前檢查雙側腎在大小一致約11cm，腎臟功能正常。安排腎臟超音波檢查後發現: 右 腎10.6 cm, 左腎8.6 cm，血液生化檢驗顯示：肌酸酐(Creatinine) 2.0 mg/dL。以下敘述，何者最正確?
(A) 9成以上患者在理學檢查有腹部雜音(bruit)且檢查血鉀[K]通常會升高。
(B) 如果腹部雜音偏側化或延伸到整個收縮期到舒張期，則它更有可能在血流動力學上具有顯著意義。
(C) 用核磁共振血管攝影(MRA)影像檢查，如果發現renal artery stenosis，通常以fibromuscular dysplasia (FMD)型最常見。
(D) 降壓劑中，以ACEI 或ARB類為首選用藥。
(E) 高血壓的原因屬先天性異常，與血清膽固醇較無關係，無需使用HMG-CoA 還原酶抑制劑( statins )控 制膽固醇。

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。  

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。

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。

114年 - 114 內科專科醫師甄審試卷 101-160#137316

114年 - 114 內科專科醫師甄審試卷 51-100#137314

114年 - 114 內科專科醫師甄審試卷 1-50#137312

113年 - 113 內科專科醫師甄審試卷 51-100#125434

113年 - 113 內科專科醫師甄審試卷 101-160#125433

113年 - 113 內科專科醫師甄審試卷 1-50#125431

112年 - 112 內科專科醫師甄審101-160#118938

112年 - 112 內科專科醫師甄審1-50#118936

112年 - 112年內科專科醫師甄審51-100#118935

111年 - 111 內科專科醫師甄審試題101-160#115089