推 Juipeter:感謝140.112.212.222 05/31
外校學長姊的版上有一篇
我加了Neonatal Jaundice進去
應該是全部吧
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TOF
The pathogenesis of TOF(tetralogy of Fallot)?
A. Anterior deviation of outlet septum B. Posterior deviation of mitral valve
C.
Rupture of ventricular septum D. Thickening of aortic valve E. Thrombosis of
co
ronary artery
Which is not the manifestation of TOF(tetralogy of Fallot)?
A. Cyanosis B. Blue spells C. Development delayed D. Seizure E. Clubbing of
fing
ers
Which is not the way to treat blue spell?
A. Knee-chest position B. Oxygenation C. Morphine(Sedation) D. β-blocker E.
Cal
cium bicarbonate
Which is not included in CATCH 22 syndrome?
A. Cardiac defects B. abnormal facies C. Thymic hypoplasia D. Cleft Palate E.
Ho
mosexuality
Which is not included in the four anomalies of TOF( tetralogy of Fallot)?
A. VSD B. Pulmonary stenosis C. Right ventricular hypertrophy D. ASD
ANS:ADEED
Febrile seizure
1. Which one is true for febrile seizure?
A. rare before 9 mo and after 5 yr of age
B. occur during the first day of a child's fever
C. excellent prognosis
D. must be carefully investigated for the cause of the fever
E. all of the above
2. Which one is not true for simple febrile seizure?
A. BT≧39℃ B. Focal C. tonic-clonic D. a few secs~10min E. postictal
drows
iness
3. Which one is true for atypical febrile seizure?
A. higher BT B. <15min, C. repeated within the same day D. postictal
generali
zed seizure activity E. all of the above
4. Which drug is effective and safe for the febrile seizure?
A.phenytoin B. Carbamazepine C. valproate D. aspirin E.diazepam
5. Which are the frequent causes of febrile seizure?
A. viral infection URI B. roseola C. AOM D. All of the above E. none
of
the above
Ans:EBCED
Viral meningoencephalitis:
1. The most common pathogen in viral meningoencephalitis is:
(1) Enterovirus
(2) Arbovirus
(3) CMV
(4) VZV
2. In most cases of meningoencephalitis, the infections are:
(1) associated with high morbidity and mortality
(2) self-limited
3. The characteristics of HSV-1 encephalitis: HSV-1 encephalitis
is usually
(1) severe; focal brain involvement
(2) mild; focal brain involvement
(3) severe; entire brain involvement
(4) mild; entire brain involvement
4. Which is "not" the CSF findings in viral meningoencephalitis?
(1) Pleocytosis with mononuclear cell predominance
(2) Protein: usually normal or slightly elevated
(3) Glucose: usually normal
(4) Pleocytosis with PMNs predominance through most of the course
ANS: (1) (2) (1) (4)
asthma&nephrotic syndrome
(A)1.小孩子nephrotic syndrome最常見的原因是？(A)minimal change disease (B)
mesangial proliferation (C)focal segmental glomerulosclerosis
(D)membranoproliferativ
e glomerulonephritis
(B)2.小孩子有nephrotic syndrome在下列哪個情況仍不需要做腎臟切片？(A)年紀小於1
歲
(B)使用steroid治療4個禮拜仍有proteinuria (C)症狀伴隨有hypertension (D)有
hematuri
a
(C)3.哪些情況可以確定診斷有Asthma？(1)FEV1/FVC<0.8 (2)在吸入β2-agonist後，
FEV1
可以增加12%以上 (3)Exercise challenge會使FEV1惡化大於15%以上 (4)早晚PEF(peak
exp
iratory flow)的變化大於20％ (A)123 (B)124 (C)234 (D)134
(D)4.下列哪一個不是Asthma長期的控制藥物？(A)cromolyn (B)oral steroid
(C)leukotri
ene modifier (D)short-acting inhaled β-agonist
Hypertrophic pyloric stenosis(HPS)
1.HPS的好發年齡是下列何者
a.0~2 weeks
b.3~6weeks
c.6~12months
d.>1 year
2. HPS一開始最常表現的臨床症狀是下列何者
a.Nonbilious vomiting
b.lethargy
c.fever
d. Failure to thrive
3.下列哪一項和HPS的可能致病原因無關
a.infant hypergastrinemia
b. decreased nitric-oxide stimulation of muscle fibers
c .the use of erythromycin in neonates
d. infection of Helicobacter Pylori
4.下列哪一項檢查是現在最常用來確定HPS診斷的工具
a.physical examination
b.ultrasound
c.UGI series
d. CT
5.關於HPS的治療，下列敘述何者錯誤
a. surgical pyloromyotomy是最有效的治療方式
b.病人即使HPS造成電解質不平衡的問題還沒矯正回來仍可以接受開刀
c.開刀後大概有一半的病人會因為手術部位的edema而有短暫性的嘔吐現象
d.病人大概術後八小時後就可以開始喝一點少量的糖水
Intussusception
1. 下列何者是Intussusception常見的臨床表徵
a. severe paroxysmal colicky pain
b. currant jelly stool
c. Lethargy
d. 以上皆是
2.下列何者是Intussusception的可能致病原因
a. swollen Peyer patches in the terminal ileum.
b. recognizable lead points such as lymphoma, neurofibroma
c. Receive of the tetravalent rhesus-human reassortant rotavirus vaccine
d. 以上皆是
3. 關於Intussusception的診斷，下列何者錯誤
a. 某些病人在作理學檢查時，可於右上腹摸到臘腸狀的mass
b. Intussusception厲害的話甚至可在肛門指檢時摸到Intussusception的脫出物
c. 不管病人情況如何，灌腸攝影(barium or air enema )都是必要的檢查
d. 超音波對Intussusception的診斷而言是一項非侵襲性且具高敏感度的工具
4. 關於各項Intussusception治療方法，在Recurrent rate的比較上下列何者正確
a. barium enema reduction > surgical reduction > surgical resection
b. surgical reduction > barium enema reduction > surgical resection
c. surgical resection > surgical reduction > barium enema reduction
d. barium enema reduction > surgical resection > surgical reduction
新生兒PE
1.下列關於新生兒的敘述何者錯誤?
(a) intermittent groaning, whining cry or grunting代表潛在可能有
cardiopulmonary
disease or sepsis
(b)如果聽到systolic murmur大部分都代表心臟有問題，需進一步做cardiac echo
(c)以一個term infants而言呼吸速率 30-40/min，甚至到60/min皆屬正常
(d)以一個term infants而言心跳速率落在90~180/min裡面是屬於正常的
答:B
2.下列關於新生兒的皮膚表現何者敘述正確?
(a)capillary hemangiomas到了一歲以後會慢慢自然消退，即使覆蓋住眼瞼也不可能影響
到將來的視力發展。
(b)Mongolian spots通常是紅色而邊緣清楚的，除了臀部以外其它地方不可能長
(c)當小朋友長大，portwine stains都會自動消失
(d)post-mature baby的皮膚通常比較pale，而且看起來皺皺的
答:D
3.下列關於新生兒的五官何者敘述正確?
(a)Epstein pearls不是一種retention cysts，而是一種念珠菌的感染
(b)Congenital glaucoma和congenital cataract不可能一起出現
(c)低位耳(low set ear)可能與一些congenital anomalies有關
(d)Precocious dentition發生率很高，且長出來的多為上門牙
答:C
4.下面的反射中哪些屬於primitive reflex?
(a)Plantar and palmar grasp reflex (b)Sucking reflex
(c)Rooting reflex (d) Moro reflex
(e)以上皆是
答:E
Kawasaki disease
1. 得到Kawasaki disease的病人，在病癒之後仍要定期追蹤哪方面的問題？
（A）呼吸系統
（B）內分泌系統
（C）泌尿系統
（D）心血管系統
答：D
2. Kawasaki disease病程分期中，最常引起sudden death是在哪一期？
（A）Acute febrile phase
（B）Subacute phase
（C）Convalescent phase
（D）以上皆非
答：B
3. 以下何者為Kawasaki disease常見的臨床表徵？
（A）Fever>5days
（B）Bilateral bulbar conjunctival injection, generally nonpurulent
（C）Changes in the mucosa of the oropharynx
（D）Cervical adenopathy, ?1.5cm, usually unilateral lymphadenopathy
（E）以上皆是
答：E
4. 以下何者不是使得到Kawasaki disease的病人outcome變差的因子？
（A）Male
（B）<1y/o
（C）Hb, platelet, albumin, age adjusted serum IgG皆上升
（D）Prolonged fever
（E）Recurrent fever after an afebrile period
答：C
thalassemia
1. Hb H (beta tetramer) inclusion body在下列哪一個疾病出現
a. beta thalassemia major
b. beta thalassemia intermediate
c. Sickle cell disease
d. Hb H disease
Ans. d
2. 父母是皆是乙型海洋性貧血帶原者,小孩子發病的機率(%)？
a. 0
b. 25
c. 50
d. 100
Ans. b
3. 國人海洋性貧血的帶原率
a. 甲型帶原率：5～6%
b. 乙型帶原率：1～3%
c. 以上皆對
d. 以上皆錯
Ans. c
4. 下列敘述何者錯誤？
a. 甲型海洋性貧血的主要原因是基因的缺失(deletion)
b. 甲型海洋性貧血的主要臨床症狀是以溶血(hemolysis)來表現
c. 乙型海洋性貧血的主要原因也是基因的缺失(deletion)
d. 乙型海洋性貧血的主要臨床症狀是以溶血(hemolysis)和造血不能(Ineffective
eryt
hropoiesis)來表現
Ans. c
5. 關於嚴重型乙型海洋性貧血( beta thalassemia major)臨床表現,何者錯誤？
a. 一出生就出現嚴重的貧血 Hb=3～7g/dL, 不輸血會導致心臟衰竭而死亡
b. 肝脾腫大
c. 髓外造血(extramedullary erythropoiesis)
d. 生長遲滯
Ans. A
ALL
1. 下列對ALL的敘述何者錯誤?
(a) 為兒童最常見的癌症, 男多於女
(b) 可做bone marrow examination確診
(c) 治療主要以chemotherapy為主, 要做CNS prophylaxis
(d) 影響prognosis的因子中, 最重要的是對treatment的response
(e) 整體而言預後相當不好, 平均五年survival rate< 50%
Ans :(e)
2. 下列ALL的病人, 何者的prognosis是較好的?
(a) Age<1y/o
(b) Initial WBC count >100,000/mm3
(c) 有t (9,22) chromosome change
(d) 染色體數目是hyperdiploid
(e) 有CNS involved
Ans :(d)
3. 下列何者是ALL病人易relapse的地方?
(a) Bone marrow
(b) CNS
(c) Testis
(d) a+b
(e) 以上皆是
Ans: (e)
neurologic evaluation
1. 以下敘述何者錯誤?
(a)病史的詢問在neurologic evaluation中是最重要的一部份。
(b)developmental milestones共分成三個部分，分別為gross motor, fine motor,
communication and language，我們可以藉此知道小孩子是否有發展上的延遲。
(c)除了病人本身的病史外，母親的病史也是很重要的，包括懷孕、陣痛、生產時及產後
的健康情況。
(d)家族史方面要注意病人雙親之間的關係，近親結婚會明顯增加代謝性及退化性疾病侵
犯中樞神經的發生率。
2. 下列有關fontanel的敘述何者正確?
(a)新生兒有兩個fontanel，一前一後。anterior fontanel呈菱形，位在coronal和
sagittal sutures junction的中線；posterior fontanel則位在intersection of
the
occipital and parietal bones之間。
(b)正常小孩子一出生posterior fontanel就會關閉，若沒有關要懷疑是不是有
hydrocephalus或是congenital hypothyroidism。
(c)Anterior的大小差異很大，平均而言是2x2cm，正常在出生後6-8週會關閉，若出生時
太
小或不見，要懷疑有premature fusion of the sutures或是microcephaly。
(d)正常的fontanel是有點凹陷的而且會有pulsatile，觀察時要讓小孩子呈頭低腳高的姿
勢
，若發現有突起的現象，可能是有顱內壓升高或是因為小孩子劇烈哭鬧的關係。
3. 下列有關腦神經評估的敘述何者錯誤?
(a)常見anosmia的原因不是神經異常，而是因為上呼吸道感染。
(b)新生兒看眼底時，optic nerve正常應該是salmon-pink的顏色，若發現有gray-white
的現象要懷疑有optic nerve atrophy。
(c)Doll's eye maneuver可用來評估不合作的新生兒或是comatose病人的眼球運動。
(d)Bilateral lesions侵犯到兩側的vagus nerves可能會導致respiratory distress。若
懷疑有lesion侵犯到vagus nerve，vocal cords的觀察是必要的。
4. 下列有關deep tendon reflex and plantar response的敘述何者正確?
(a)Deep tendon reflex從1到4分成四級，正常為2，1是完全消失，4是顯著的
hyperactive
(b)最常檢測的有三個地方，biceps, knee及ankle jerks。
(c)小孩子的Ankle jerks檢查方式就是輕敲Achilles tendon，正常可看到plantar
flexion及gastrocnemius muscle收縮。
(d)Babinski reflex因為新生兒神經發展尚不完全，所以從出生到一歲都會是positive，
一歲半到兩歲以後等神經發展完全就會變成negative了。
5. 在term infant身上，下列哪一個primitive reflex不是一出生時就可明顯呈現的?
(a)Palmar grasp reflex
(b)Rooting reflex
(c)Moro reflex
(d)Tonic neck reflex
答案：b a b b d
VSD
1.Which one is the most common cardiac malformation?
(A)Atrial Septal Defect
(B)Ventricular Septal Defect
(C)Tetralogy of Fallot
(D)Endocardial Cushion Defect
(E)Patent Ductus Arteriosus
2.Which of the following statements is right?
(A)The most type of VSD is the membranous type, which may be more associated
with other manifestations of the tetralogy of Fallot than the other VSD
types.
(B)The muscular type of VSD are less common.It is just beneath the pulmonary
valve and may impinge on an aortic sinus and cause aortic insufficiency.
(C)Swiss cheese septum is more related to the supracristal type.
(D)VSD Between the crista supraventricularis and the papillary muscle of
theon
us may be associated with pulmonary stenosis.
(E)None of above.
3.Which of the following statements about a VSD patient is wrong?
(A)If the left-to-right shunt is small (Qp:Qs <1.75:1), the cardiac chambers
are not appreciably enlarged and the pulmonary vascular bed is probably
normal.
(B)In a nonrestrictive VSD patient, the direction of shunting and shunt
magnitude are determined by the ratio of pulmonary to systemic vascular
resistance (Rp/Rs)
(C)If the shunt is large (Qp:Qs >2:1), patient's LA & LV volume overload
occurs, as does RV & pulmonary arterial hypertension.
(D)In some infants with a large VSD, pulmonary vascular obstructive disease
develops. When the ratio of pulmonary to systemic resistance approaches
1:1, the shunt becomes bidirectional, the signs of heart failure abate,
and the patient becomes cyanotic.
(E)All of above are right.
4.About Indications for surgical closure of a VSD, which one is wrong?
(A)Patients at any age with large defects in whom clinical symptoms and
failure to thrive cannot be controlled medically.
(B)Severe pulmonary vascular disease.
(C)Patients older than 24 m/o with a Qp:Qs ratio greater than 2:1.
(D)Patients with supracristal VSD of any size
(E)ALL of above are right
5.Which one may be less useful for diagnosis of a VSD?
(A) Chest radiograph
(B) Electrocardiogram
(C) Two-dimensional echocardiogram
(D) Cardiac catheterization
(E) Computed tomography
答案：B D E B E
1. 下列何者不是診斷Juvenile Rheumatoid Arthritis(JRA)的標準？
(a) Age of onset < 16 yr
(b) Arthritis
(c) Duration of disease > 1 month
(d) Exclusion of other types of rheumatoid arthritis
答 c
2. 下列何者不是Juvenile Rheumatoid Arthritis (JRA)的臨床表現？
(a) Loss of cervical lordosis
(b) Initial presentation of hip involvement in oligoarticular JRA
(c) Evanescent salmon colored rash
(d) Arthritis of large joints
答 b
3. Juvenile Rheumatoid Arthritis (JRA)的poor prognostic factor?
(a) Rheumatoid Factor (+)
(b) Antinuclear antibody (+)
(c) Younger age of onset
(d) Oligoarthritis
答 a
4. 下列何者可用來治療Juvenile Rheumatoid Arthritis (JRA)?
(a) NSAID
(b) Methotrexate
(c) Azathioprine(d) Corticosteroid
(e) 以上皆是
答 e
Hematuria
1.Myoglobinuria without RBCs最有可能出現在下列哪種狀況？
(a) hemolytic anemia
(b) rhabdomyolysis syndrome
(c) Alport syndrome
(d) SLE nephritis
2.下列哪一種情形不像是源於glomerulus的hematuria？
(a) cola-colored, or burgundy urine
(b) proteinuria > 100mg/dL
(c) blood clots
(d) deformed urinary RBCs
3.Acute nephritic syndrome的典型狀況不包括下列何者？
(a) renal colic
(b) cola-colored urine
(c) edema
(d) hypertension
4.最常見的gross hematuria原因是？
(a) trauma
(b) glomerulonephritis
(c) urolithiasis
(d) urinary tract infection
ANS:
bcad
Neonatal Jaundice
(1) 以下哪個敘述是錯的?
(a) The rate of physiologic jaundice is less than 5mg/dl/24hr
(b) Direct-bilirubin > 2mg/dl at any time needs further evaluation
(c) Direct hyperbilirubinemia may have neurotoxicity and lead to
kernicterus
(d) Breast milk jaundice may persist for 3-10 wk at lower level
Ans: C
(2)以下關於Breast milk jaundice和Breast feeding jaundice 哪個正確?
(a) Breast milk jaundice是因為初分泌的母奶水份和熱量不足所引起
(b)當寶寶發生Breast milk jaundice,若馬上停止餵母乳則血中bilirubin數值會在
幾天後馬上回到正常值
(c) Breast feeding jaundice 的發生通常在7天之後
(d) 以上皆是
Ans: B
(2) 以下有關Phototherapy的敘述何者錯誤?
(a) Breast milk jaundice是因為初分泌的母奶水份和熱量不足所引起
(b)當寶寶發生Breast milk jaundice,若馬上停止餵母乳則血中bilirubin數值會在
幾天後馬上回到正常值
(c) Breast feeding jaundice 的發生通常在7天之後
(d) 以上皆是
Ans: B
(3) 以下有關Phototherapy的敘述何者錯誤?
(a) 照的光是可見光中的藍光420-470nm
(b) 它是利用Photo-isomerization的原理
(c) Porphyria的病人不適合照光
(d) 在足月兒Bilirubin level > 15mg/dl和出現kernicterus是照光的適應症
Ans: D
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