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)

24. 關於胃腸道基質瘤(gastrointestinal stromal tumor, GIST)，何者錯誤：(1) 台灣小腸腫瘤中第二常見的類型(2) 最好發在胃(60%-70%)，多於小腸，再來是食道及大腸等等(3) 治療藥物 Imatinib(Glivec)是一種 tyrosine-kinase inhibitor(4) 診斷上無論期數皆需先取得切片的病理報告(5) 有 Platelet derived growth factor receptor(PDGRA)基因突變的 GIST 較KIT gene 者多(A) (1)＋(2)(B) (1)＋(4)(C) (3)＋(5)(D) (4)＋(5)(E) (2)＋(3)

25. 關於胃腺癌的預防，以下敘述何者錯誤？(A) 幽門桿菌屬第一級的致癌因子，佔胃腺癌 80%的成因(B) 根據 Kimura-Takemoto classification system，開放型的萎縮性胃炎較閉鎖型有較高的癌化機率(C) 根據 EGGIM(Endoscopic grading of gastric intestinal metaplasia)，總體分數 4 分以上有較佳的敏感度及特異度來預測 stage III-IV 的 OLGIM(Operative link on gastric intestinal metaplasia assessment)(D) 男性，幽門桿菌感染，年紀大於 40 歲，及居住在高胃癌發生率地區，較高機會有慢性萎縮性胃炎(E) 高 PG(Pepsinogen)I 跟高 PG I/II 的比例者是胃癌的高風險族群

26. 關於胃部淋巴瘤的表現何者錯誤：(1) 大約佔胃部腫瘤的 5%，主要是 mucosal associated lymphoid tissue(MALT)lymphoma 及 diffuse large B cell lymphoma 的表現為主(2) 根據 Lugano stage，MALT lymphoma 第一期的患者建議開刀切除(3) PGIL(Primary GI tract lymphoma)最常見於胃(60%)(4) 臨床上同淋巴瘤常見 B symptoms(發燒，夜間盜汗，體重減輕)(5) MALT lymphoma 的預後(MALT IPI)與年紀，LDH 高低，期別有關(A) (1)＋(4)(B) (2)＋(3)(C) (2)＋(4)(D) (3)＋(5)(E) (3)＋(4)

27. 下列何者皆為"胃癌"的危險因子(1) EBV, HSV(2) 抽菸，菸草使用(3) atrophic gastritis, Intestinal metaplasia(4) 黑斑息肉症候群(Peutz-Jeghers Syndrome)，Ménétrier disease(5) 酗酒，吃 NSAID 止痛藥(A) (1)＋(2)＋(3)(B) (2)＋(3)＋(4)(C) (2)＋(3)＋(5)(D) (1)＋(2)＋(4)(E) (1)＋(2)＋(3)＋(4)

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.