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.

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.

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)

39. 消化道結核的敘述，下列何者正確？(1) 大腸結核病患者常見胸部 X 光有活動性結核病灶(2) 肺外結核中，消化道結核較淋巴結核、骨及關節結核少見(3) 腸結核內視鏡下表現可分為 ulcerative lesions(占 60%)、ulcerohypertrophiclesion(占 30%)以及 Hypertrophic lesions(占 10%)(4) 結核性腸炎組織學下 50%~80%可看見肉芽腫，典型肉芽腫在結節中央有乾酪性壞死，但不一定會以典型來表現，需要與其他疾病來鑑別診斷(5) Crohn’s disease 內視鏡下常有 Linear ulcer，ileocecal valve incompetence，cobble stones，可以和 TB colitis 做鑑別診斷(A) (1)＋(2)＋(3)(B) (2)＋(3)＋(4)(C) (3)＋(4)＋(5)(D) (1)＋(4)＋(5)(E) (1)＋(2)＋(5)

40. 下列有關艱難梭菌感染(Clostridium difficile infection)的敘述，何者正確？(1) 常見引起 CDI 的抗生素有 ampicillin, amoxicillin, cephalosporins，但是fluoroquinolones 或 trimethoprim-sulfamethoxazole 則比較少見(2) Clostridium difficile 致病位址(Pathogenicity locus)長度約 19.6Kb，包含五個基因(Tcd A-E)，Tcd A、Tcd B 轉譯成 Toxin A、Toxin ，Tcd D 基因產物會正向調節 Toxin A、B 轉譯，Tcd C 則負向調節 Toxin 製造，Tcd E 可能和毒素釋放有關(3) 2023 年，FDA 核准了第一個經由口服的 FMT 新藥 VOWST(Seres Therapeutics)，將健康人工糞便經由加工處理留下 Bifidobacteriaceae 的孢子，製成口服膠囊，目前 FDA 僅核可治療 recurrent CDI，並不適用於 primaryCDI(4) FMT 減少 Clostridium difficile infection 復發的機轉，可能跟 short chain fattyacid 以及 secondary bile acid 下降有關(5) Clostridium innocuum diarrhea 可能在 CDI 治療後產生，通常對 Vancomycin治療反應佳(A) (1)(B) (2)(C) (3)(D) (4)(E) (5)