28. 請問下列有關"胃癌"的敘述何者正確？
(1) 多吃富含 Vit.C 食物可降低胃癌機會
(2) 低社經地位的人，得到胃癌機會較高
(3) 胃竇的胃癌，肥胖是危險因子之一
(4) statin 類藥物，有保護的作用
(A) (1)＋(2)＋(3)＋(4)
(B) (2)＋(3)＋(4)
(C) (1)＋(2)＋(4)
(D) (1)＋(2)＋(3)

(E) (1)＋(2)

29. 關於小腸腺癌(adenocarcinoma)，下列何者錯誤？(1) 腺癌(adenocarcinoma)是最常見的小腸原發性惡性腫瘤(2) 腺癌(adenocarcinoma)由腺瘤(adenomas)或化生不良(dysplasia)而來(3) 小腸腺癌(adenocarcinoma)危險因子包含 Acquired immunodeficiency syndrome 及 Type 1 neurofibromatosis(4) 小腸腺癌(adenocarcinoma)常與家族性腺瘤性息肉症(Familial adenomatous polyposis)相關(5) Lynch syndrome 相關腺癌預後比家族性腺瘤性息肉症(Familial adenomatous polyposis)相關腺癌更差(A) (3)＋(4)(B) (1)＋(2)＋(3)(C) (1)＋(3)＋(5)(D) (2)＋(4)＋(5)(E) (2)＋(3)＋(4)＋(5)

30. 使用 Lauren’s classification 將胃癌分類成瀰漫型胃癌(Diffuse type gastric cancer)與腸型胃癌(Intestinal type gastric cancer)，以下何者錯誤？(1) 腸型胃癌盛行率有下降的趨勢，並且以男性較常發生(2) signet-ring cell 是腸型胃癌的特殊表現(3) 腸型胃癌與慢性萎縮性胃炎和腸上皮化生有關(4) 瀰漫型胃癌會形成皮革胃(linitis plastica)，並且與幽門螺旋桿菌(H. pylori)感染高度相關(5) 瀰漫型胃癌常有染色體不穩定性(chromosomal instability)並與家族發生性(familial occurrence)相關(A) (1)＋(4)(B) (1)＋(2)＋(3)(C) (2)＋(3)＋(4)(D) (2)＋(4)＋(5)(E) (1)＋(2)＋(3)＋(4)＋(5)

31. 下列關於腸道吸收與分泌的描述，何者正確？(1) serotonin reuptake transporter may be decreased in patients with diarrhea-predominant IBS (IBS-D).(2) Bile acid associated fluid loss is linked to the diarrhea of IBD and IBS-D, involve the inhibition of NaCl absorption, and/or stimulation Cl− secretion.(3) Supplementation of zinc in oral rehydration solution (ORS) was observed to decrease the number of diarrheal episodes and stool volume.(4) Glucocorticoids are potent stimulators of Na+ absorption in both the small intestine and colon.(A) (1)＋(2)(B) (2)＋(3)(C) (1)＋(4)(D) (1)＋(2)＋(3)(E) (1)＋(2)＋(3)＋(4)

32. 下列關於 Intestinal ischemia 的敘述，何者為非？(A) Acute mesenteric ischemia (AMI) of SMA can involve all or part of the small intestine and the left half of the colon.(B) Unexplained abdominal distention or GI bleeding may be the only symptoms of when AMI is caused by Nonocclusive mesenteric ischemia (NOMI).(C) CT angiogram is highly accurate in the detection of occlusive disease of the SMA but is not as reliable for NOMI.(D) NOMI is responsible for ∼20% of AMI episodes and usually has preceding cardiovascular event.(E) The standard of care for NOMI remains correction of the underlying condition that prompted splanchnic vasoconstriction and angiography with SMA infusion of PGE1.

33. 下列關於 Colonic ischemia 的敘述，何者為非？(A) Colonic ischemia is a common disorder of the large bowel in older persons and is the most common form of intestinal ischemic injury.(B) Colonic ischemia has a female gender predilection.(C) Male gender, abdominal pain without hematochezia, WBC ＞15 × 103/L, Hgb＜12.0 g/dL, BUN ＞20 mg/dL, LDH ＞350 U/L are risk factors associated with poor outcome.(D) Antimicrobial treatment is recommended when colonic ischemia diagnosed.(E) Patient with severe disease ＞ 3 risk factors for poor outcome or peritoneal sign should arrange CTA or mesenteric angiography.

34. 下列關於 Short bowel syndrome(SBS)的敘述，何者為非？(A) Ca2+ and Mg2+ absorption decrease on a low-fat diet in patients with small intestinal resections.(B) Vitamin B12 malabsorption usually is demonstrable when more than 60 cm of ileum has been resected.(C) More extensive ileal resections (＞100 cm) cause severe bile acid malabsorption, which can result steatorrhea.(D) Patients with SBS and a preserved colon have increased GLP-1 and GLP-2 concentrations and demonstrate normal gastric emptying.(E) Patients with the highest GLP-2 concentration following a meal are most likely to be successfully weaned from parenteral nutrition.

35. 下列關於 diverticular bleeding 的敘述，何者為非？(A) It is the most common cause of significant LGIB in adults.(B) It is often a diagnosis of presumption and exclusion framed by the presence of diverticulosis, and the absence of other identifiable sources.(C) NSAIDs including aspirin, have been associated with an increased risk of diverticular bleeding.(D) Patients often pass melena due to venule bleeding.(E) Bleeding ceases spontaneously in 70% to 80% of patients.

36. 針對 Small intestinal bacterial overgrowth(SIBO)，下列敘述何者正確？(1) 傳統 SIBO 診斷標準是在迴腸進行 aspirate and quantitative culture，細菌數量超過 100000 cfu/ml，但是花費昂貴，且屬於侵入性檢查(2) 現在最常使用 C13-d-xylose breath test 診斷，但是有偽陽性的問題，且遠端小腸細菌增生可能無法偵測到(3) 可能和 Gastroparesis、Hypothyroidism、irritable bowel syndrome、Long-term high dose acid suppression 有關(4) SIBO 會產生 secondary bile salts(如 lithocholic acid)，直接抑制脂肪吸收，導致脂溶性維生素缺乏(5) SIBO 可能導致 Megaloblastic anemia 以及 Protein-losing enteropathy(A) (1)＋(2)＋(3)(B) (2)＋(4)＋(5)(C) (3)＋(4)＋(5)(D) (1)＋(2)＋(4)＋(5)(E) (1)＋(2)＋(3)＋(4)＋(5)

37. 關於 IBD(inflammatory bowel disease)敘述何者正確？(1) 即使 Ulcerative colitis 沒有侵犯到盲腸，periappendiceal inflammation(cecal patch)也很常見(2) 克隆氏症(Crohn’s disease)腸道外表現可能有 peripheral arthritis、osteoporosis、pancreatitis、PSC、erythema nodosum、Uveitis(3) 目前評估 Ulcerative colitis 嚴重度的 Mayo score 評估指標有 4 項，包括 stoolfrequency、Rectal bleeding、mucosal appearance、distribution，每項 0-3分，最高 12 分(4) 經診斷為 Ulcerative colitis 廣泛性腸炎者，應立即開始每 2~3 年篩檢大腸癌(5) Vedolizumab 為一種 anti-TNF-α製劑，研究顯示可能可以提高克隆氏症臨床緩解率(A) (1)＋(2)(B) (1)＋(5)(C) (2)＋(3)(D) (3)＋(5)(E) (4)＋(5)

38. 目前微菌治療在消化道疾病應用的研究，下列何者有較足夠的證據？(1) 可以減少 Necrotizing enterocolitis 發生率、死亡率、住院時間(2) 可以預防 antibiotics-associated diarrhea 以及 Clostridioides difficile-associated diarrhea 復發(3) 可以降低嬰幼兒急性腸胃炎進展至中重度與住院的機率(4) 糞菌移植(FMT)有對於輕度至中度的克隆氏症誘發緩解有效(5) 克隆氏症(CD)和潰瘍性結腸炎(UC)患者的腸道微生物群中特別缺乏Faecalibacterium prausnitzii，這種細菌被認為具有潛在的抗發炎特性(A) (1)＋(2)＋(3)(B) (2)＋(3)＋(4)(C) (3)＋(4)＋(5)(D) (1)＋(4)＋(5)(E) (1)＋(2)＋(5)

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