92. 胰臟癌發生的危險因子？
(1) 遺傳性胰腺炎
(2) IPMN/MCN
(3) 糖尿病
(4) Peutz-Jeghers syndrome
(A) (1)＋(2)＋(4)
(B) (2)＋(3)＋(4)
(C) (1)＋(3)＋(4)
(D) (1)＋(2)＋(3)

(E) (1)＋(2)＋(3)＋(4)

88. 一位 50 歲男性病患，因肺炎至急診住院。病人為愛滋病患，因故未接受治療，血液檢查：血紅素 10gm/dL，白血球 5,000/uL，血小板 110,000/uL，麩胺酸丙酮酸轉胺基酶(ALT)80U/L，鹼性磷酸酶(ALP)400U/L，總膽紅素(T-Bil)5.5mg/dL，HIV 抗體陽性，CD4 淋巴球數為 9 cells/uL，HIV 病毒負荷量(HIV viral load)為 2 x 107/mL，核磁共振膽胰道攝影(MRCP)發現近端總膽管擴張而末端平滑變細，肝內膽管有不規則的狹窄與擴張。下列何者為最常見的伺機感染(opportunistic infection)？(A) Cryptosporidium parvum(B) Cytomegalovirus (CMV)(C) Microsporidia(D) Giardia intestinalis(E) Pneumocystis jirovecii

89. 60 歲女性健康狀況良好，在健診時，腹部超音波發現膽囊結石且膽囊壁上呈現連續鈣化點，病患並無症狀，門診安排腹部電腦斷層發現膽結石，膽囊壁內點狀鈣化。以下何者為最恰當的下一步處理？(A) 轉介外科行膽囊切除(B) 安排內視鏡超音波(EUS)(C) 安排核磁共振攝影(MRI)(D) 安排半年後腹超追蹤(E) 有症狀再回診治療

90. 關於經口膽道內視鏡(peroral choangioscopy)的組織敘述何者為真？(1) 可以提高原因不明的膽道狹窄(indeterminate bililary stricture)的診斷率(2) 導管式膽道內視鏡(catheter cholangioscopy 如 Spyglass)，不需要切開或擴張乳突，可以降低出血風險(3) 和傳統的 ERCP 碎石與取石比較，經口膽道鏡的碎石與取石，結石的清除率較高，術後發生膽管炎的機會相當(4) 導管式膽道內視鏡，因為膽道空氣壓力增加，增加術後發生空氣栓塞(airembolism)的併發症(5) 以超細鏡內視鏡(ultrathin endoscope)，施行經口膽道內視鏡的影像品質，較導管式膽道內視鏡為佳(A) (1)＋(5)(B) (1)＋(4)(C) (3)＋(4)＋(5)(D) (1)＋(3)＋(4)＋(5)(E) (1)＋(2)＋(5)

91. 會造成胰管擴張的胰臟腫瘤有下列哪些？(1) 胰臟腺癌(2) 胰臟淋巴癌(3) 神經內分泌瘤(4) 胰管內乳突黏液性腫瘤－混和型(IPMN-main pancreatic duct type)(5) 發炎偽性腫瘤(A) (1)＋(2)(B) (1)＋(2)＋(4)(C) (1)＋(3)＋(4)(D) (1)＋(4)＋(5)(E) (3)＋(4)＋(5)

93. 關於胰臟癌篩檢的敘述，何者不恰當？ (A) 高危險族群，應每年監控血糖 (B) CA199 是最優的血液篩檢工具 (C) MRI/MCRCP 及 EUS 是最危險族群的影像篩檢工具 (D) 高危險族群建議 50 歲開始進行篩檢 (E) 對於年紀大、有許多共同不適合手術的危險族群則不需要篩檢

94. Which of following statements is incorrect？(A) The term hemorrhagic pancreatitis is a synonym for necrotizing pancreatitis(B) Acute pancreatitis is defined by 3 criteria - symptoms consistent withpancreatitis, a serum amylase or lipase level greater than 3 times the upperlimit, and radiologic imaging consistent with pancreatitis(C) Acceptable markers of severe pancreatitis include 3 or more of Ranson’s 11 criteria for nongallstone pancreatitis 13 and an Acute Physiology and Chronic Health Evaluation (APACHE-II) score above 8(D) After a period of approximately 4 weeks, if the acute peripancreatic fluidcollections persist and develop a wall, then they are called a “pseudocyst.”(E) Necrotic collections, which may also be peripancreatic, develop a wall after 4 weeks and are then referred to as WON

95. Which of following statements are incorrect about acute pancreatitis (AP)？(1) There is no specific drug therapy to treat AP(2) Long-term NPO is not suggested(3) Morphine has been shown to adversely affect outcome in acute pancreatitis(4) NG intubation is not used routinely(5) Routine use of PPIs or H2RAs have been shown to be beneficial for acute pancreatitis(A) (2)＋(4)(B) (3)＋(5)(C) (1)＋(5)(D) (2)＋(3)(E) (1)＋(5)

96. Which of following statements are correct？(1) The initial step in the pathogenesis of AP is conversion of trypsinogen to phospholipase A2 within acinar cells(2) Pancreatic secretory trypsin inhibitor (now called SPINK1) is a protective intrapancreatic mechanisms(3) The first phase of acute pancreatitis usually lasts a week and ischaracterized by systemic symptoms that may result in organ failure(4) Approximately 75% to 80%, of patients with AP have a resolution of the disease process(A) (1)＋(2)＋(4)(B) (2)＋(3)＋(4)(C) (1)＋(3)＋(4)(D) (1)＋(2)＋(3)(E) (1)＋(2)＋(3)＋(4)

97. Which statements about chronic pancreatitis is/are incorrect？(1) Tobacco use is one very important cofactor for the development of alcoholic chronic pancreatitis(2) Men are more likely than women to develop alcoholic chronic pancreatitis(3) some cases with pancreatitis attack due to hypertriglyceridemia willultimately develop chronic pancreatitis(4) The response to sphincter ablation in patients with chronic pancreatitis andpresumed sphincter of Oddi dysfunction is predictable(A) (1)＋(4)(B) (2)＋(3)(C) (3)＋(4)(D) (1)(E) (4)

98. Which statements about treatment of chronic pancreatitis is incorrect？(A) For pain relief, most of patients with chronic pancreatitis require more potent narcotic agents(B) Narcotics should not be withheld in patients with severe pain(C) High dosages of tramadol are equivalent to oral morphine in treating chronic pancreatitis, with fewer effects on gut motility(D) A trial of enzymes for pain is usually successful in those with advancedchronic pancreatitis with diffuse calcifications or a dilated pancreatic duct(E) The primary goal of endoscopic therapy is to improve drainage of the pancreatic duct by relieving ductal obstruction