38. 下列關於 Clostridium difficile infection(CDI)敘述，何者不正確？
(1) Clostridium difficile is anaerobic spore-forming bacillus
(2) Disturbance of gut microbiota diversity by antibiotics may lead to Clostridium difficile overgrow
(3) Metronidazole or Vancomycin is first line treatment for CDI
(4) CDI can be completely cured by single episode of Fecal microbiota transplantation(FMT)
(5) Recurrence rate of CDI 可高達 40-60% with subsequent antibiotic exposure
(A) (1)
(B) (2)
(C) (3)
(D) (4)

(E) (5)

34. Meckel’s diverticulum 有下列幾個臨床上的特性，其中何者為非？(1) 最常見的症狀是出血(2) 成年人若核子醫學檢查(Tc-99m pertechnetate scintigraphy 稱為 Meckel’sscan)為陰性，幾乎可以排除 Meckel’s diverticulum 的可能性(3) 好發位置在遠端迴腸，距離迴盲瓣(ileocecal valve)不到 100 公分處(4) 為先天性病灶(5) 有症狀的人比完全沒有症狀的人還多(A) (1)＋(2)(B) (3)＋(4)(C) (2)＋(5)(D) (1)＋(4)(E) (4)＋(5)

35. 下列關於 Impact of oral antibiotics on gut microbiota 敘述，何者正確？(1) 使用抗生素可導致腸道菌相明顯改變(2) 對於肥胖受試者給于 Vancomycin 會改變腸道菌相，但不改變腸道菌的代謝物(3) 抗生素造成宿主肥胖可能源自於抗生素改變腸道菌的代謝物(4) 畜牧業早已飼料中添加 subtherapeutic dose 抗生素作爲生長促進劑(5) 各種肉品中抗生素的殘留量檢測出零，代表無殘留、完全對人類無害(A) (1)(B) (2)(C) (2)＋(3)＋(4)(D) (1)＋(3)＋(4)(E) (1)＋(2)＋(3)＋(4)＋(5)

36. 下列關於 gut microbiota 敘述，何者正確？(1) Development of non-alcoholic fatty liver disease was influenced by host genetic polymorphisms, diet, gut microbiota(2) Gut-liver axis plays important role in metabolism, immune system education,tolerance development and prevention of pathogen colonization(3) Gut dysbiosis correlated with mortality in acute on chronic liver failure(4) Decreasing gastrointestinal motility in cirrhotic patient contributes to bacterial overgrowth(5) Fewer bacteroidetes, higher proportions of Proteobacteria and Fucobacteria were noted in cirrhotic patient(A) (1)＋(2)(B) (1)＋(3)(C) (2)＋(3)＋(4)(D) (1)＋(2)＋(3)＋(4)(E) (1)＋(2)＋(3)＋(4)＋(5)

37. 下列關於 Host-Microbes relationships 敘述，何者不正確？(1) For most infants, human microbiome is seeded by vertical (maternal)transmission during birth(2) If delivery is by cesarean section, the founding bacteria resemble those of cutaneous origin, predominantly lactic acid-producing bacteria(3) A healthy intestine is characterized by a diverse and versatile microbiota(4) Disturbances of host-microbe interaction by antibiotics during infancy,increases the risk of immuno-allergic disorders(5) Bacteroidetes and Firmicutes contribute to ≈ 90% of the species in the proximal bowel(A) (1)＋(2)(B) (2)＋(3)(C) (3)＋(4)(D) (2)＋(5)(E) (3)＋(4)＋(5)

39. 下列關於 Obesity 敘述，何者正確？(1) Obesity increases risk of cardiovascular disease, type 2 diabetes, fatty liver, certain type of cancers(2) Increase ratio of Fimicutes to Bacteroidetes is found in obese people(3) Dual specificity phosphatase 6 ( dusp 6) deficiency promotes insulin sensitivity、confer host resistance to diet-induced obesity(4) Gut microbiota altered mucosal immunity、host metabolism and energybalance(5) Dusp 6 now considered an important regulator of hepatic gluconeogenesisand lipid metabolism(A) (1)＋(2)(B) (1)＋(3)(C) (1)＋(2)＋(3)＋(4)＋(5)(D) (1)＋(3)＋(4)(E) (1)＋(2)＋(3)＋(5)

40. 下列關於 gut microbiota 敘述，何者正確？(1) Eubiotic gut microbiota is composed of diverse bacterial community(2) Fat-enriched diet lead to gut microbiota dysbiosis(3) Gut microbiota dysbiosis impairs the crosstalk between phagocytes, innate lymphoid cells and T cells(4) High fat diet consumption alters innate and adaptive immune cell populations、contribute to low grade chronic inflammation(5) Gut dysbiosis-induced low grade inflammation leads to diabetes(A) (1)＋(2)＋(3)(B) (1)＋(4)＋(5)(C) (1)＋(2)＋(3)＋(4)＋(5)(D) (1)＋(2)＋(3)＋(4)(E) (1)＋(2)＋(3)＋(5)

41. 發炎性腸道疾病(Inflammatory bowel disease)的病患，發生大腸直腸癌(colorectal cancer)的風險會提高，以下何者為是？(1) 亞洲的發炎性腸道疾病(Inflammatory bowel disease)病患的大腸直腸癌(colorectal cancer)盛行率，比西方國家的低(2) 被診斷腸炎後的 8-10 年，產生大腸癌的風險開始顯著上升(3) 臨床上克隆氏症盛行率比潰瘍性大腸炎高(4) 全結腸炎(Pancolitis)的病人風險比左側腸炎(left-side colitis)的病人來的低(A) (1)＋(2)＋(3)＋(4)(B) (1)＋(2)＋(3)(C) (2)＋(3)(D) (1)＋(2)

42. 歐洲克隆氏症與結腸炎組織(European Crohn’s and Colitis Organisation；ECCO)對於發炎性腸道疾病(Inflammatory bowel disease)的病患，所建議的篩檢大腸鏡檢查(Screening colonoscopy)，以下何者為是？(1) 建議在腸炎症狀出現的隔年開始每一至兩年進行一次大腸鏡檢查，以監控疾病活性(2) 建議在腸炎症狀出現的第八年之後開始進行篩檢大腸鏡檢查(3) 有 Post-inflammatory polyps 的病患建議 2-3 年後接受追蹤大腸鏡檢查(surveillance colonoscopy)(4) Pseudo-polyp 應施行息肉切除術，以免進展為大腸癌(A) (1)＋(3)＋(4)(B) (2)＋(3)＋(4)(C) (2)＋(3)(D) (1)＋(4)

43. 對於診斷遺傳性非息肉大腸直腸癌(Hereditary Nonpolyposis Colorectal Cancer)的阿姆斯特丹準則(Amsterdam II Criteria)，以下何者為是？(1) 家族成員中有 3 人以上罹患大腸直腸癌(colorectal cancer)，其中一位患者是其他 2 位病患的一等親(2) 至少有二個世代以上的家族成員罹患大腸直腸癌(colorectal cancer)(3) 病患中至少有一人之年齡必須小於 40 歲(4) 家族性腺性息肉症(Familial adenomatous polyposis；FAP)亦可屬之(A) (1)＋(2)＋(3)＋(4)(B) (1)＋(3)(C) (1)＋(2)(D) (1)＋(2)＋(4)

44. 遺傳性非息肉大腸直腸癌(Hereditary Nonpolyposis Colorectal Cancer)主要是導因於核甘酸誤配修補基因(mismatch repair [MMR] genes)的缺陷，目前已知與 HNPCC 致癌有關的 MMR 基因包括以下何者？(1) hMSH2(2) hMLH1(3) hMSH5(4) hPMS1(A) (1)＋(2)＋(3)＋(4)(B) (1)＋(2)＋(3)(C) (1)＋(2)(D) (1)