81. 下列何者會抑制膽囊的收縮？
(A)迷走神經
(B)激膽囊素(cholecystokinin)
(C)胰泌素(secretin)
(D)胃泌素(gastrin)

(E)腸動素(motilin)

77. 關於 HCC systemic therapy，依據 phase 3 clinical trials 的結果，下列敘述何者正確？(1) Atezolizumab + Bevacizumab 在一線 systemic therapy，objective response rate (ORR) ＞25%(2) Lenvatinib 在一線 systemic therapy，objective response rate (ORR) ＞20%(3) Sorafenib 在一線 systemic therapy，最好的 median overall survival 可以超過 14 個月(4) Median progression-free survival (PFS)，lenvatinib 不輸於 Atezolizumab +Bevacizumab(A) (1)(B) (1)＋(2)(C) (1)＋(2)＋(3)(D) (1)＋(2)＋(3)＋(4)(E) (1)＋(3)

78. 關於 HCC radioembolization(TARE)or Selective internal radiation therapy(SIRT)的敘述，下列何者正確？(1) There was no significant difference in OS between sorafenib and TARE in SIRveNIB and SARAH studies for advanced HCC(2) Current data demonstrate benefit of TARE compared to sorafenib in patients with advanced HCC(3) Compared to TACE, SIRT provides significantly longer time to progression and better tumor control, but it does not provide longer survival(4) SIRT might prepare or select patients for surgery as it induces substantial hypertrophy in the liver lobe contralateral to the target(A) (2)(B) (1)＋(2)＋(3)(C) (2)＋(3)＋(4)(D) (1)＋(2)＋(3)＋(4)(E) (1)＋(3)＋(4)

79. 關於 Cholangiocarcinoma(CCA)的敘述，下列何者正確？(1) Adjuvant chemotherapy with capecitabine for 6 months after surgical resection with curative intent is recommended for intrahepatic CCA(2) Liver transplantation is a potentially curative option for intrahepatic and perihilar CCA(3) FOLFOX (folinic acid, fluorouracil and oxaliplatin) can be recommended as second- line standard of care chemotherapy(4) Combination of cisplatin and gemcitabine is the standard of care for patients with unresected tumors(5) Cirrhosis is one of the risk factors of intrahepatic CCA(A) (2)＋(4)(B) (1)＋(2)＋(3)＋(4)(C) (2)＋(3)＋(4)(D) (1)＋(2)＋(3)＋(4)＋(5)(E) (1)＋(2)＋(4)

80. 關於 HCC image diagnostic performance 的敘述，下列何者正確？(1) Dynamic plus hepatobiliary phase MRI had a higher sensitivity and negative predictive value than multiphasic CT and dynamic phase MRI alone(2) Gadoxetic acid is unique in that approximately 50% of the administrated dose is taken up by the hepatocytes and excreted into the bile ducts(3) On gadoxetic acid enhanced MRI, hyper-intensity on hepatobiliary phase is regarded as an ancillary finding favoring malignancy(4) Gadoxetic acid-enhanced MRI has a higher sensitivity for detecting nodules that are either HCC not displaying the typical features of imaging hallmarksor high-grade dysplastic nodules(A) (2)(B) (1)＋(2)＋(4)(C) (1)＋(2)(D) (1)＋(2)＋(3)＋(4)(E) (2)＋(4)

82. 下列何者不是 Rome IV criteria(Clinical criteria for diagnosis of functional gallbladder and sphincter of Oddi disorders)中所描述的膽道型疼痛(biliarypain)？(1)疼痛位於上腹部或右上腹(2)每次疼痛大於 30 分鐘(3)反覆發作但是不定間隔時間(4)嚴重疼痛影響日常生活，或需求助急診(5)疼痛常伴隨腹瀉(A) (2)＋(4)(B) (1)＋(3)(C) (4)(D) (5)(E) (2)＋(5)

83. 下列何者是黑色素結石(black pigment gallstones)的危險因子？(1)肥胖(2)肝硬化(3)慢性溶血(4)靜脈營養(5)快速體重下降(A) (1)＋(2)＋(3)(B) (2)＋(3)＋(4)(C) (3)＋(4)＋(5)(D) (1)＋(3)＋(4)(E) (2)＋(3)＋(5)

84. 有關阻塞性黃疸的描述何者為錯？(1)膽道內正常壓力為 15-25 cm H2O(2)膽道阻塞後壓力上升，會促進膽汁進一步分泌(3)阻塞後膽汁溢出會造成局部肝細胞壞死(4)壓力上升後只有膽紅素(bilirubin)會被抑制而膽鹽(bile salts)則正常分泌(5)長期膽管阻塞，會產生白色膽汁(white bile)(A) (2)＋(5)(B) (1)＋(3)＋(4)(C) (5)(D) (2)＋(4)(E) (3)＋(4)＋(5)

85. 一位 60 歲病患，因為阻塞性黃疸住院，並無感染症狀，身體狀況良好，術前電腦斷層檢查懷疑是胰臟頭部腫瘤，膽胰管擴張，並無明顯轉移，外科評估可以切除，下列何者為是？(1)術前檢查可檢查 IgG4，以排除不典型的自體免疫胰臟炎(autoimmune pancreatitis)(2)應進行 ERCP/ERBD 放置塑膠支架引流，等黃疸正常後再請外科施行胰十二指腸切除術(pancreaticoduodenectomy)(3)術前如果外科或家屬要求需要病理診斷，可以施行 EUS-FNA/B(4)行 ERCP 時如無特別需要，可以不必裝置胰管支架做胰管引流(A) (1)＋(2)＋(3)＋(4)(B) (2)＋(3)＋(4)(C) (1)＋(2)＋(4)(D) (1)＋(3)＋(4)(E) (3)＋(4)

86. 下面那些是目前預防 ERCP 術後胰臟炎可行的方法？(1)預防性類固醇注射(2)術前或術後馬上使用 indomethacin 100mg 塞劑(3)術前或術後馬上使用 diclofenac 75mg 注射(4)高風險者預防性胰臟支架放置(5) Lactated ringer 積極輸液(3ml/kg/hr)(A) (2)＋(3)＋(4)＋(5)(B) (1)＋(3)＋(4)(C) (1)＋(4)＋(5)(D) (2)＋(3)＋(5)(E) (2)＋(4)＋(5)

87. 一位 60 歲女性病患，平時健康狀況良好，因急性上腹痛至急診住院。理學檢查，病患並無發燒或黃膽，上腹壓痛明顯但無腹膜症候(peritoneal sign)。生化檢查： ALT:740, AST:600, ALP:120, r-GT:100, Amylase:1400, Lipase:2000。腹部超音波與電腦斷層顯示輕度脂肪肝，膽囊壁稍微增厚與數顆大於 1 公分的膽結石，膽管未見擴張，胰臟稍腫但無週邊積水。兩天後病患症狀迅速改善，追蹤生化檢查顯示：ALT:300, AST:150, ALP:100, rGT:60, Amylase:85, Lipase:200。追蹤腹超胰臟未見周邊積水膽管也未見擴張和結石(附註：正常值(單位：IU/L)：ALT:7-56,AST:5-35, ALP:38-126, r-GT:8-78, Amylase:30-110, Lipase:7-60)。下列何者為較適當的後續處理：(A)照會外科行腹腔鏡膽囊切除術(B)照會外科行膽囊切除術與總膽管取石(C)施行 ERCP，如有結石再施行 EST 取石(D)不論總膽管是否有結石，直接施行 ERCP/EST/膽管結石清除(E)症狀改善不需後續治療