一０六年度內專筆試題

一０六年度內科專科醫師考試筆試題 -- 血液科

(E) 1. 下列疾病與目前已知有效之治療藥物的配對，何者是錯誤的？

A. Multiple myeloma: Lenalidomide

B. Chronic myeloid leukemia: Dasatinib

C. Diffuse large B-cell lymphoma: Rituximab

D. Paroxysmal nocturnal hemoglobinuria: Eculizumab

E. Polycythemia vera: Prednisolone

(B) 2. 一位72歲病人因為出血傾向及疲倦應診，抽血檢查顯示血紅素為8.2 g/dL，白血球24000/uL，血小板12000/uL；血液抹片如圖所示。這位病人最可能得了何種病？

A. Chronic myeloid leukemia

B. Chronic myelomonocytic leukemia

C. Chronic lymphocytic leukemia

D. Acute myeloid leukemia

E. Acute lymphoblastic leukemia (ALL)

(D) 3. 一位23歲病人因呼吸急促應診，血液檢查顯示血紅素為6.3 g/dL，血小板、白血球及分類正常，網狀紅血球(reticulocyte) 3.5%，全膽紅素 (total bilirubin) 3.4 mg/dL，直接膽紅素 (direct bilirubim) 0.7 mg/dL；血液抹片如圖所示。此位病人最可能得了什麼病？

A. Iron deficiency anemia

B. Autoimmune hemolytic anemia

C. Vit B12 deficiency anemia

D. Thalassemia

E. G6PD deficiency

(A) 4. 標靶治療藥物Tyrosine kinase inhibitor, Imatinib, 對下列何種急性淋巴芽細胞白血病(ALL)有效？

A. B-lineage ALL with t(9;22)

B. B-lineage ALL with t(4;11)

C. CD19 positive B-lineage ALL

D. CD20 positive B-lineage ALL

E. CD3 positive T-lineage ALL

(D) 5. Eltrombopag目前為健保給付治療免疫性血小板低下性紫斑症(immune thrombocytopenic purpura)的第二線用藥，它的作用機轉為何？

A. Anabolic hormone

B. Corticosteroid

C. Immunosuppressive agent

D. Thrombopoietin receptor agonist

E. JAK inhibitor

(E) 6. 一位病人因血小板低下應診，下列各項檢驗中何者為鑑別血小板低下原因幫忙最小者？

A. H. pylori infection

B. Serology tests for SLE

C. Hepatitis C infection

D. HIV infection

E. Platelet antibodies

(D) 7. 對於多發性骨髓瘤(multipel myeloma)的診斷及分期，下列何項檢查是最不需要者？

A. Immunoelectrophoresis

B. Albumin level

C. Beta 2-microglobulin level

D. Bone scan

E. Plain bone radiography

(A) 8. 一位40歲病人抱怨胃痛，內視鏡檢查發現胃竇(gastric antrum)有一腫瘤，病理切片檢查顯示為mucosa-associated lymphoid tissue lymphoma，CD20陽性及H. pylori陽性，分期檢查未發現其他異常。下列何者為此病人最適當的第一線治療？

A. Eradication of H. pylori

B. Rituximab

C. Chemotherapy

D. Rituximab + Chemotherapy

E. Local irradiation

(D) 9. 下列何種狀況常會出現prothrombin time (PT)正常但activated partial thromoplostim time (aPTT)延常的現象？(1) Hepatic failure；(2) Antiphospholipid syndrome；(3) von Willebrand disease；(4) Disseminated intravascular coagulation

A. (1)+(4)

B. (2)+(4)

C. (1)+(2)

D. (2)+(3)

E. (1)+(2)+(4)

(B) 10. 下列何者是B細胞慢性淋巴性白血病(chronic lymphocytic leukemia)細胞的特徵，可與反應性淋巴細胞過多症做鑑別診斷？(1) Monoclonal light chain restriction；(2) CD5 expression；(3) CD10 expression

A. (1)

B. (1)+(2)

C. (1)+(3)

D. (2)+(3)

E. (1)+(2)+(3)

< 一０六年度試題目錄 >

(E)	1.	下列疾病與目前已知有效之治療藥物的配對，何者是錯誤的？
		A.	Multiple myeloma: Lenalidomide
		B.	Chronic myeloid leukemia: Dasatinib
		C.	Diffuse large B-cell lymphoma: Rituximab
		D.	Paroxysmal nocturnal hemoglobinuria: Eculizumab
		E.	Polycythemia vera: Prednisolone

(B)	2.	一位72歲病人因為出血傾向及疲倦應診，抽血檢查顯示血紅素為8.2 g/dL，白血球24000/uL，血小板12000/uL；血液抹片如圖所示。這位病人最可能得了何種病？
		A.	Chronic myeloid leukemia
		B.	Chronic myelomonocytic leukemia
		C.	Chronic lymphocytic leukemia
		D.	Acute myeloid leukemia
		E.	Acute lymphoblastic leukemia (ALL)

(D)	3.	一位23歲病人因呼吸急促應診，血液檢查顯示血紅素為6.3 g/dL，血小板、白血球及分類正常，網狀紅血球(reticulocyte) 3.5%，全膽紅素 (total bilirubin) 3.4 mg/dL，直接膽紅素 (direct bilirubim) 0.7 mg/dL；血液抹片如圖所示。此位病人最可能得了什麼病？
		A.	Iron deficiency anemia
		B.	Autoimmune hemolytic anemia
		C.	Vit B12 deficiency anemia
		D.	Thalassemia
		E.	G6PD deficiency

(A)	4.	標靶治療藥物Tyrosine kinase inhibitor, Imatinib, 對下列何種急性淋巴芽細胞白血病(ALL)有效？
		A.	B-lineage ALL with t(9;22)
		B.	B-lineage ALL with t(4;11)
		C.	CD19 positive B-lineage ALL
		D.	CD20 positive B-lineage ALL
		E.	CD3 positive T-lineage ALL

(D)	5.	Eltrombopag目前為健保給付治療免疫性血小板低下性紫斑症(immune thrombocytopenic purpura)的第二線用藥，它的作用機轉為何？
		A.	Anabolic hormone
		B.	Corticosteroid
		C.	Immunosuppressive agent
		D.	Thrombopoietin receptor agonist
		E.	JAK inhibitor

(E)	6.	一位病人因血小板低下應診，下列各項檢驗中何者為鑑別血小板低下原因幫忙最小者？
		A.	H. pylori infection
		B.	Serology tests for SLE
		C.	Hepatitis C infection
		D.	HIV infection
		E.	Platelet antibodies

(D)	7.	對於多發性骨髓瘤(multipel myeloma)的診斷及分期，下列何項檢查是最不需要者？
		A.	Immunoelectrophoresis
		B.	Albumin level
		C.	Beta 2-microglobulin level
		D.	Bone scan
		E.	Plain bone radiography

(A)	8.	一位40歲病人抱怨胃痛，內視鏡檢查發現胃竇(gastric antrum)有一腫瘤，病理切片檢查顯示為mucosa-associated lymphoid tissue lymphoma，CD20陽性及H. pylori陽性，分期檢查未發現其他異常。下列何者為此病人最適當的第一線治療？
		A.	Eradication of H. pylori
		B.	Rituximab
		C.	Chemotherapy
		D.	Rituximab + Chemotherapy
		E.	Local irradiation

(D)	9.	下列何種狀況常會出現prothrombin time (PT)正常但activated partial thromoplostim time (aPTT)延常的現象？(1) Hepatic failure；(2) Antiphospholipid syndrome；(3) von Willebrand disease；(4) Disseminated intravascular coagulation
		A.	(1)+(4)
		B.	(2)+(4)
		C.	(1)+(2)
		D.	(2)+(3)
		E.	(1)+(2)+(4)

(B)	10.	下列何者是B細胞慢性淋巴性白血病(chronic lymphocytic leukemia)細胞的特徵，可與反應性淋巴細胞過多症做鑑別診斷？(1) Monoclonal light chain restriction；(2) CD5 expression；(3) CD10 expression
		A.	(1)
		B.	(1)+(2)
		C.	(1)+(3)
		D.	(2)+(3)
		E.	(1)+(2)+(3)