86.急性腎損傷(acute kidney injury,AKI為病房中患者常見之腎臟問題,請問相關的 評估與處置何者錯誤?
(A)臨床上評估的工具常見的有RIFLE criteria及AKIN criteria兩者皆是使用serum creatinine 數值的改變及小便尿量的多家來訂定AKI的嚴重度,兩者预測住院中死 亡率並無不同
(B)可因為感染症、手術後、低血容積問題、心臟功能不佳及腎毒性藥物等造成急性 腎損傷,評估時需找出其造成急性腎損傷的原因進行治療及處置
(C)急性腎損傷早期處置需先給子crystalloids或colloid 輸液治療以提高腎臟血流
(D)為改善腎功能及避免輸液所造成的肺水腫,應該儘早給予利尿劑furosemide,但 低劑量dopamine則不建議用

1.下列有關 actinomycosis感染何者為非? (A)大於50% thoracic actinomycosis病患有pleural involvement (B)治療plural actinmycosis可使用高劑量penicillin，治療期間需較長 (C)處置其pleural effusion與細菌造成pleural effusion相似 (D)Pleural effusion中,主要發炎血球為 eosinophil

2.下列有關cryptococcosis感染何為非? (A)Pleural involvement是因為subpleural cryptococcal nodules 侵犯入肋膜腔 (B)所有pleural cryptococcosis病患接受systemic antifungal therapy (C)大多數有cryptococcal pleuraal effusion病患為immunosupprssed (D)其pleural effusion為exudate,主要發炎血球為small lmphocyte

3.下列有viralpneumonia關敘述,何者為非? (A) During influenza outbreaks, most patients can be diagnosed on clinical grounds alone (B) Real-time reverse-transcriptase PCR is the test of choice to diagnose influenza (C) Viral culture takes approximately 2 to 5 days to yield a result, is less sensitive than PCR (D) 75% of healthy adult harbor a virus without symptom

4. 下列有關孕婦使用藥物敘述,何者為非? (A) Oral glucocorticoids should not be used during pregnancy when indicated for the management of severe asthma (B) Albuterol is recommended as the short-acting 82 agonist of choice (C) Budesonide is the preferred inhaled glucocorticoid for use during pregnancy (D) Montelukast could be consider as an alternative but not preferred therapy for persistent asthma

5. 下列有關慢阻肺(COPD)之藥物治療,何者為非 (A)Antimuscarinic drugs 制支氣管收縮乃藉由作用於於平滑肌上M3 muscarinic receptors (B) Long-acting B2-agonist 效持續12小時以上,此時 as-neededshort-acting B2-agonist使用也沒助益 (C) Short-acting antimuscarinics也阻上inhibitory neuronal receptor M2,所以可能造 成支氣管收縮 (D)Long-acting antimuscarinic (tiotropium)可改善症狀和健康,亦改善肺復健效果

6.下列有關敗血症之藥物治療,何者為非? (A)敗血症或敗血性休克病患若有gastointinal bleeding風險者可使用stress ulcer prophylaxis (B)在呼吸器使用之敗血症病患建議減少continuous or intermittent sedation (C)在敗血症導致acute respiratory distsss syndrome(ARDS)病患,若無bronchospasm 不建議使用B2 agonists (D)在敗血症導致ARDS病患，且Pa O2/FiO2 ratio

7.下列有關肺炎之藥物治療,何者為非? (A) Ventilator-associated pneumonia (VAP)病患,建議治療療程7day course (B)病患因P.aeruginosa hospital-acquired pneumonia(HAP)/VAP沒有休克或高死 亡風險,在抗生素敏感測試未出前,建議單一藥物治療即可 (C)病患因ESBL-producing gram-negative baclli HAP/VAP,建議依抗生素敏感測試藥 物治療,並參酌病患特性 (D)病患因P.aeruginosa HAP/VAP,建議首選 aminoglycoside monotherapy 治療

8.下列有關黴菌感染中pulmonary cryptococcosis何者為非? (A) Immune reconstitution inflammatory syndrome (IRIS) may complicate treatment of any opportunistic mycosis,少見於cryptococcosis. (B)肺部侵犯可以從無症狀到多肺葉consolidatin甚至acute respiratory distress syndrome (C)輕度至中度單獨肺部感染,治療可用fluconazole 400 mg/day至少6至12 months (D)Cryptococcus可以在respiratory specimens 培養 including sputum and bronchoalveolar lavage.

9.下列有關COPD藥物之描述何者錯誤? (A) Some patients with refractory dyspnea will experience improved exercise tolerance with theophylline (B) For patients with recurrent exacerbations (eg, at least two per year or one requiring hospitalization) despite triple inhalers, the phosphodiesterase-4 inhibitor roflumilast may reduce the frequency of exacerbations (C) For patients with recurrent exacerbations prolonged use of azithromycin may reduce the frequency of exacerbations (D) Azithromycin should be avoided in patients with a short QT interval

10.下列有關藥物之描述何者錯誤? (A) Angiotensin-converting enzyme (ACE) inhibitors-induced cough. 咳嗽常在停藥4天 內消失 (B)估計up to 5% of asthmatics are sensitive to aspirin;ingestion may case fatal aggravation of bronchospasm. (C) Methotrexate-associated pneumonitis is almost always irreversible with or without the addition of corticosteroids. (D) A most unusual adverse effect of corticosteroids is mediastinal lipomatosis, the deposition of mediastinal fat, which produces a widening of the mediastinum that mimics lymphadenopathy or other neoplasms

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