65. 肝穿刺是診斷各種肝臟疾病的重要參考與標準，下列有關肝穿刺與病理檢查診斷各種肝臟疾病的描述，何者為正確的？
(1)肝穿刺檢體太小無法提供足夠的資訊，檢體長度應至少 1.5~2cm
(2)肝穿刺與病理檢查可以應用於診斷病因、評估嚴重度與治療反應
(3)肝穿刺檢查的安全性很高，發生內出血的機會僅約 5/100
(4)肝穿刺與病理檢查診斷可以精準判斷藥物引發的肝損傷(drug-induced liver injury, DILI)
(A) (1)＋(2)＋(3)＋(4)
(B) (1)＋(2)＋(4)
(C) (1)＋(2)＋(3)
(D) (1)＋(2)

(E) (3)＋(4)

61. 31 歲女性病患來急診時，主訴最近一個星期茶色尿，嗜睡，無法清楚詢問疾病史，家屬描述病患過去沒有肝臟病史，去年健康檢查肝功能正常。急診的檢驗資料顯示血清 albumin 2.6 g/dL (reference value ＞3.5)，total bilirubin level: 23.5 mg/dL(reference value ＜1.0)，direct bilirubin level: 11.4 mg/dl (reference value ＜0.3)，ALT level 60 IU/L (reference value ＜40)，AST level 45 IU/L (reference value＜40)，ALP level 94 IU/L (reference value ＜100)，PT INR 2.8 (reference value＜1.1)，以下何項評估或描述是合理的？(1)病患可能發生急性肝衰竭(2)在亞太地區病毒性肝炎是造成急性肝衰竭最常見原因(3) acetaminophen 過量服用則是西方國家造成急性肝衰竭常見原因(4)腦水腫和顱內高壓是急性肝衰竭特殊併發症(5)肝臟移植是最後一線治療方式(A) (1)＋(2)＋(3)＋(4)＋(5)(B) (1)＋(2)＋(3)＋(4)(C) (1)＋(3)＋(4)＋(5)(D) (1)＋(2)＋(4)＋(5)(E) (2)＋(3)＋(4)

62. 下列關於威爾森氏症(Wilson Disease, WD)說明，哪些描述是正確的？(1)威爾森氏症是一種影響鐵離子代謝的遺傳性疾病，除了肝臟以外也會影響腦部和眼睛(2)威爾森氏症是自體隱性遺傳性疾病，影響 ATP7B 基因(3)所有得到威爾森氏症的患者都要終身接受治療，包括沒有症狀的基因異常帶原者(4)口服治療藥物包括 D-penicillamine 和 zinc salts(5)藥物治療無效或發生急性肝衰竭時應考慮肝移植(A) (1)＋(2)＋(3)＋(4)＋(5)(B) (1)＋(2)＋(3)＋(5)(C) (1)＋(2)＋(4)＋(5)(D) (2)＋(4)＋(5)(E) (2)＋(5)

63. 下列各項有關酒精性肝病(alcoholic liver disease)的敘述，何者正確？(1)酒精性肝病是西方國家常見造成肝硬化的原因(2)合併 C 型肝炎會加速肝臟疾病惡化速度(3)戒酒是治療酒精性肝病最重要的步驟(4) Pentoxifylline 被證實可以改善嚴重酒精性肝炎(5)發生失代償肝硬化，當戒酒六個月仍沒有改善時應評估肝移植需要性(A) (1)＋(2)＋(3)＋(4)＋(5)(B) (1)＋(2)＋(3)＋(5)(C) (2)＋(4)＋(5)(D) (1)＋(2)＋(3)(E) (2)＋(3)＋(5)

64. 下列有關於非酒精性脂肪肝病(non-alcoholic fatty liver disease, NAFLD)之敘述，何者是不正確的？(A)非酒精性脂肪肝病為一症候群，涵蓋單純脂肪變性(simple steatosis)、非酒精性脂性肝炎(non-alcoholic steatohepatitis, NASH)、纖維化以及肝硬化(B)非酒精性脂肪肝病發生與肥胖以及胰島素抗性(insulin resistance)有密切相關，體型瘦者也會得 NAFLD(C)非酒精性脂性肝炎(non-alcoholic steatohepatitis, NASH)的病理診斷要件包括 steatosis, ballooning and lobular inflammation(D)非酒精性脂性肝炎(non-alcoholic steatohepatitis, NASH)存在時，患者有較高機會得到肝硬化，但不會發生肝細胞癌

66. 肝癌 HCC 的第 2 線 systemic therapy，依據第 3 期臨床試驗(1) KEYNOTE 240(2) RESORCE(3) REACH-2(4) CELESTIAL其中 2 線藥物相對於 placebo，overall survival(OS)的 Hazard ratio(HR)的數值，由最低到最高排列順序為？(A) (2)-(3)-(4)-(1)(B) (4)-(2)-(3)-(1)(C) (1)-(2)-(3)-(4)(D) (2)-(1)-(3)-(4)(E) (3)-(2)-(4)-(1)

67. 關於 Liver Imaging Reporting and Data System(LI-RADS)system，下列敘述何者錯誤？(1) LI-RADS 1 and LI-RADS2 indicate definitely and probably benign(2) LI-RADS 3 indicates a low probability of HCC(3) “a small nodular area of CT/MR arterial phase hyperenhancement, which is not present on other phases” is classified as LI-RADS 2(4) “a ≥2-cm encapsulated lesion with CT/MR arterial phase hyperenhancement, but without “washout” is classified as LI-RADS 4(5) “a ≥2-cm lesion that enhances to the same degree as liver in the CT/MR arterial phase, but enhances less (i.e., is hypoenhanced) in the postarterial phases” is classified as LI-RADS 3(A) (1)＋(4)(B) (2)＋(3)(C) (3)(D) (2)＋(3)＋(5)(E) (3)＋(5)

68. GALAD model 可以運用在 HCC 診斷，下列何者不屬於 GALAD model 的組成項目？(A) Platelet count(B) AFP-L3%(C) DCP(protein induced by vitamin K absence/antagonist-II)(D) Sex(E) Age

69. 依據 2018 EASL Clinical Practice Guidelines 關於 BCLC 的敘述，下列何者錯誤？(1) Very early HCC (BCLC stage 0) is defined as the presence of a single tumor＜2 cm in diameter without vascular invasion/satellites in patients with good health status (ECOG-0) and well-preserved liver function (Child-Pugh Aclass)(2) Early HCC (BCLC stage A) is defined in patients presenting with single tumors ＞2 cm or three nodules ＜3 cm in diameter, ECOG-0 and preservedliver function(3) Large solitary HCC beyond 5 cm should be classified as BCLC B(4) Among BCLC B, Child-Pugh B patients with refractory ascites and hepatic encephalopathy, liver transplantation should not be considered(A) (3)(B) (4)(C) (1)＋(3)(D) (3)＋(4)(E) (2)＋(3)

70. 依據 2018 HCC EASL Clinical Practice Guidelines，下列何者錯誤？(1) Liver resection is recommended for single HCC of any size and in particular for tumors ＞2 cm, when hepatic function is preserved, and sufficientremnant liver volume is maintained(2) Assessment of response in HCC should be based on RECIST1.1 for loco-regional therapies(3) For systemic therapies both mRECIST and RECIST1.1 are recommended to assess the response(4) HCC with tumor-related portal vein thrombosis (PVTT) can be graded as PV1 (segmentary), PV2 (secondary order branch), PV3 (first order branch),and PV4 (main trunk/contralateral branch)(5) Liver resection can be considered for PV1/2 extension of HCC(A) (3)(B) (2)(C) (2)＋(3)(D) (3)＋(4)(E) (2)＋(5)

71. 依據 2018 HCC EASL Clinical Practice Guidelines，Liver transplantation 的敘述下列何者錯誤？(1) Liver transplantation is recommended as the first-line option for HCC within Milan criteria but unsuitable for resection(2) Consensus on expanded criteria for liver transplantation in HCC has not been reached(3) UCSF criteria include single nodule ≤5 cm or 2–3 nodules ≤3 cm and total tumor diameter ≤6.5 cm(4) Total tumor volume (TTV) criteria + alpha-fetoprotein (AFP) defined as TTV＜115 cm3 and AFP ＜400 ng/ml(A) (3)(B) (2)(C) (2)＋(3)(D) (3)＋(4)(E) (2)＋(4)