推 ALegmontnick:done 06/20 17:51
※ 編輯: fallenseraph 來自: 140.112.244.29 (06/20 22:24)
課程名稱︰醫學資訊學與實證醫學
課程性質︰系所必修
課程教師︰陳恆順等人
開課學院：醫學院
開課系所︰醫學系
考試日期（年月日）︰2009/06/16
考試時限（分鐘）：90
是否需發放獎勵金：是
（如未明確表示，則不予發放）
試題 :
一. 是非題：（每題1.5分，共9分）
1. 幾乎所有的疾病都是基因與環境因素交互作用所致。
2. 資訊科技的進步有助醫學研究，但對臨床診療沒有太大幫助。
3. 人類基因體計劃之成果加上許多週邊科技之進步，我們現在可以同時追蹤許多
基因之型態與表達。
4. 只有少數疾病是單基因突變引起的，大部分情況是人們帶有容易罹患病的基因
，再加上其他基因或環境因素的變化，導致發病。
5. 藉由基因檢測可以檢查是否有容易罹患某種疾病傾向的基因，有助於提早採取
預防措施。
6. 當基因測出病人具有突變型BRCA基因時，醫生應立即告知病人親屬他們亦有罹
癌風險。
二. 選擇題：（每題1.5分，共72分）
1. 下列敘述何者正確？請選出最佳答案。
a. 基因資訊有預測及評估風險的性質
b. 基因檢測後病人可能面臨各種臨床選擇，例如：墮胎、改變生活型態
c. 醫師於基因檢測前對病人的告知同意比檢測後的諮商來的重要
d. 基因資訊對於個人在人際、心裡及社會層面都可能造成影響
(A) a+b+c
(B) b+c+d
(C) a+b+d
(D) a+c+d
2. 有關基因資訊（genetic information）的特殊性，下列敘述何者正確？選最佳答案
a. 基因資訊的意涵與運用同時關乎『個人』與『家庭』
b. 基因資訊之使用影響極大，各國皆以立法規範之
c. 基因資訊時常和未來才會發生的疾病有關
d. 基因檢測所確認之疾病許多目前尚無有效治療或預防方法
(A) a+b+c
(B) a+c+d
(C) b+c+d
(D) a+b+d
3. 下列何者是施行基因檢測時，常見的倫理問題？請選出最佳答案。
a. 檢測前醫師對病人的知情同意
b. 檢測後對病人基因資訊的保密
c. 檢測後造成病人心裡傷害或社會歧視
d. 醫師替病人基因資訊保密，但有要警告可能有離病風險的家屬
(A) a+c+d
(B) b+c+d
(C) a+b+c
(D) a+b+c+d
4. 常見的病人床邊監視系統，所監視的生理資訊不包括：
(A) 心電圖
(B) 呼吸
(C) 血壓
(D) 膀胱壓
5. 一般而言，在醫院中哪一個部門較少使用病人生理間視系統：
(A) 急診處
(B) 加護病房
(C) 藥局
(D) 新生兒重症觀察室
6. 下列何者說明為真：
(A) 生理資訊監視系統常用於重症患者
(B) 由於電子業的進步，現在床邊監視器已可成為居家設備
(C) 床邊監視器主要的功能是設在病房邊的電腦用LCD螢幕
(D) 目前床邊監視器設計上會包括一個CCD camera，以紀錄患者的臉色
7. 下列哪一個系統不是用來監測患者的循環系統功能：
(A) 心電圖
(B) 血壓計
(C) 血氧計
(D) 血糖計
8. 常用的生理資訊監測系統是用來監測患者的生命徵象，而生命徵象不包括：
(A) 體溫
(B) 脈搏
(C) 血氧
(D) 血壓
9. 對於加護病房監視系統的說明，下列說明哪樣為是？
(A) 加護病房中的患者往往都需要使用病人監視系統
(B) 加護病房的護理站中會設有中央監視系統，以監視每個患者的情況
(C) 在監視系統上可以患者的狀況設定警報值，以適時發出警告
(D) 於加護病房中的系統常使用無線網路作為床邊監視器與中央監視系統之間的連線
10. 飾演超人的美國男星 Christopher Reeve 1995 年參加一次馬術比賽時發生意外，
造成高位頸部脊椎損傷 (High-level spinal cord injury)，下列何者不是他因此
所可能面臨的問題？
(A) Pressure sore (褥瘡)
(B) Quadriplegia (四肢癱瘓)
(C) Respiratory dysfunction (呼吸障礙)
(D) Aphasia (失語症)
11. 由 mRNA 製造出 protein 的過程稱為
(A) Translation
(B) Transcription
(C) Duplication
(D) Hybridization
12. 下列何者最能代表錢煦院士在醫工研究上的主要貢獻？
(A) Tissue engineering
(B) Vascular bioengineering
(C) Magnetic resonance imaging
(D) Nanotechnology
13. 人類視網膜(Retina)中的哪一層結構距離瞳孔最遠？
(A) 感光層(photoreceptor layer)：包括視桿細胞及視錐細胞
(B) 視神經纖維(nerve fiber layer)
(C) 神經節細胞層(ganglion cell layer)
(D) outer plexiform layer
14. 人類視網膜上對光線最敏感的部位稱之為？
(A) Retina
(B) Sclera
(C) Fovea
(D) Optic disc
15. 所謂subretina implant通常裝在視網膜的哪一層？
(A) 感光層(photoreceptor layer)：包括視桿細胞及視錐細胞
(B) 視神經纖維(nerve fiber layer)
(C) 神經節細胞層(ganglion cell layer)
(D) outer plexiform layer
16. 關於奈米粒子的 Enhanced premeation and retention effect，下列何者為真？
(A) 腫瘤組織附近血管較正常血管滲透性高
(B) 奈米粒子能滲透進入癌化組織
(C) 奈米粒子可以在腫瘤組織停留較長的時間
(D) 以上皆是
17. 奈米藥物傳輸系統有何優勢？
(A) 減輕systemic side effect
(B) 延長藥物在血液循環存留的時間
(C) 具passive targeting的特點
(D) 以上皆是
18. 下列何者不屬於光切片（optic biopsy）的範疇？
(A) photodynamic detection
(B) photochemical internalization
(C) optic coherent tomography
(D) narrow band image endoscopy
19. 下列哪種人類幹細胞有多元完整的自我再生與分化能力？
(A) Embryonic stem cell (胚胎幹細胞)
(B) Cord blood stem cell (臍帶血幹細胞)
(C) Hematopoietic stem cell (造血幹細胞)
(D) Mesenchymal stem cell (間質幹細胞)
20. 下列各項敘述何者錯誤？
(A) 腎臟移植與骨髓移植是目前人質人數最多、成功率最高的二種主要器官移植
(B) 骨髓移植捐贈者與病人間人類白血球抗原 (Human leukocyte antigen, HLA)
配對要求高於其他器官移植
(C) 植體抗宿主反應 (graft-versus-host-reaction, GVHR)最常發生於心臟移植
(D) HLA抗原系統位於人類第6對染色體上
21. 下列哪種幹細胞科技最有可能達成人類返老還童的夢想，但也有最多的倫理爭議？
(A) 從女人經血中分離出幹細胞
(B) 從骨髓中分離出幹細胞，轉殖成神經細胞質入腦中，讓年老失憶者記憶變好
(C) 把動物心臟細胞括除乾淨，留下心臟器官架構(scaffold)，值入人類幹細胞
培養成一個完整的心臟，作為心臟移植器官來源
(D) 皮膚表皮細胞體外培養，值入幾個關鍵基因，誘導體細胞還原成多功能幹細胞
(Induced pluripotent stem cell, IPS)
22. 下列各項敘述何者為正確？
(A) 從遺傳性疾病、癌症，到感染性疾病、心血管疾病，以至於風濕性關節炎均
可用基因治療
(B) 基因治療採用的方式分為ex vivo與in vivo兩種
(C) ex vivo 方式操作容易，基因轉植較有效率
(D) 常用病毒載體系統包括線病毒，線病毒相關病毒AAV，反轉錄病毒如HIV等載體
(E) 以上皆對
23. 下列哪些治療法屬於細胞治療的一種？
(A) 紅血球輸血
(B) 骨髓移植
(C) 自然殺手細胞(Natural killer cell)治療
(D) 臍帶血幹細胞移植
(E) 以上皆對
24. 骨髓移植前要做人類白血球抗原(Human leukocyte antigen, HLA)配對，請問
每一位同胞兄弟姊妹間HLA配對完全相同的機會有多高？
(A) 1/2
(B) 1/3
(C) 1/4
(D) 1/5
(E) 1/8
25. 關於小胖威力症(Prader-Willi Syndrome) 下列敘述何者正確？
(A) 出生體重較重
(B) 除了體種以外，還有其他異常如先天性心臟病等問題
(C) 有些小胖威力症的患者無法從染色體核型分析或用螢光原位雜交法來確定診斷
(D) 生過患者的夫妻，下一胎再生到同樣症狀的機會為1/4
26. 遺傳諮詢，請選出最適當的下一步：
An ultrasound study in a 22-year old woman at 20 week's gestation reveals
spina bifida in the fetus. The cerebral ventricles are slightly enlarged.
After the counselor discusses with the parents the diagnosis and the
unpredictability of the outcome, the woman expresses her reluctance to
terminate the pregnancy. Her husband is very quiet and says that he will
abide by his wife's decision.
(A) support the woman's decision
(B) engage the husband in the decision-making process
(C) refer the couple for family therapy
(D) refer the couple to a spina bifida support group
(E) suggest that the couple continue this discussion at home
27. 關於基因檢測，下列敘述何者正確？
(A) 在病患已出現疑似某些遺傳疾病的症狀時，醫師可以直接安排基因檢測，
以確定診斷
(B) 當個人知道自己可能是某種自體顯性遺傳疾病帶因者，雖然現在未生病，
他們還是應接受帶因者檢測以預測未來是否會發病
(C) 每個成年人都應該接受禿頭基因檢測及高血脂基因檢測
(D) 當個人知道自己可能是某種自體隱性遺傳疾病帶因者，他們可以自行決定
要不要接受帶因者檢測
28. 下列哪項檢驗可以驗出所有的基因異常？
(A) Methylation-sensitive PCR
(B) Spectrum karyotyping (SKY)
(C) Comparative genomic hybridization
(D) 以上皆是
(E) 以上皆非
29. Which of the following statements regarding pharmacogenomics is incorrect?
(A) Individual variations in drug response might be attributed to genetic
differences between human subjects.
(B) The application of genomic information to drug therapy is referred to
as pharmacogenomics.
(C) The addition of pharmacogenetic knowledge will further enhance the
cost and lengthen the process of new drug development.
(D) The accuracy of genomic test is still a problem if pharmacogenomic
knowledge be applied to current daily practice.
30. The estimated number of genes in whole human genomic is approximately:
(A) 10000 to 15000
(B) 30000 to 40000
(C) 50000 to 60000
(D) Greater than 70000
31. Which of the followings is an example of human genetic polymorphism?
(A) blood type
(B) single nucleotide polymorphism (SNP)
(C) short tandem repeat polymorphism (STRP)
(D) restriction fragment length polymorphism (RFLP)
(E) All of the above
32. Which of the following statements about drug development is incorrect?
(A) Pharmacogenetic information is mandatory in the approval process of
FDA (Food and Drug Administration) in the United States.
(B) The process of new drug development is a lengthy and costly process.
(C) In modern countries, the approval of a new drug is highly regulated.
(D) The mandatory phases of clinical trials before drug approval in the
United States include phase I, phase II and phase III.
33. Which of the following statements is incorrect?
(A) The cytochrome P450 system is responsible for metabolism of many drugs.
(B) Genetic variations in the cytochrome P450 system is one of the reasons
for variations in drug responses.
(C) Variations in drug responses might be caused by variations in drug
targets.
(D) Knowledge in genomic medicine is not suitable for finding new drug
targets.
34. Which of the following drug reaction might be influenced by genetic
variations in the human genome?
(A) Treatment efficacy of a new drug
(B) Side effects of drugs
(C) Effective dose of drugs
(D) Absorption and metabolism of drugs
(E) All of the above
35. About e-Health, which description is incorrect?
(A) e-Health is an emerging field in the intersection of medical
informatics, public health and business.
(B) e-Health application, educational and primary prevention approaches
are more effective and cost higher.
(C) e-Health refers to health services and information delivered or
enhanced through the internet and related technologies.
(D) e-Health characterizes not only a technical development, but also a
state-of-mind, a way of thinking, to improve health care locally,
regionally, and worldwide by using information and communication
technology.
36. For the reason why Taiwan needs Telemedicine, which is wrong in the
following answers?
(A) High portion of land is in mountainous area
(B) Poor medical resources in rural area
(C) Geographic barrier for isolated islets
(D) Long distance for people to access medical care
37. The 3 stages of Telemedicine in Taiwan, which is wrong in these answers?
(A) During Initiation Research Stage, different bandwidth and network
platform were tested.
(B) During Promotion Research Stage, different specialities and
applications were in trials.
(C) During Implementation Stage, the telemedicine system was integrated
with community health information system.
(D) Family folder system was not developed in the stage of Implemention
Stage.
38. From e-Health to u-Health, which is wrong in the following answers?
(A) Aging population is estimated to reach 20% in Taiwan in 2030.
(B) Sensor Network, Security measures, Standards for health information,
Decision support and Service model are all part of the elements in
u-Health.
(C) Ubiquitous Healthcare focuses on recovery from illness.
(D) The future prospects for u-Health development require synchronization
with government policy, promotions and collaboration with industry
and international organizations.
39. The NTU u-Health system comprises of several external systems, which is not
correct?
(A) Community Medical Group Health Information System
(B) Call Center Health Management System
(C) Hospital Information System
(D) PACS System
40. Image processing is increasingly important because of the following
reasons except:
(A) to extract relevant information from the raw data
(B) to perform trans-modality image fusion
(C) to reconstruct 3D images from large amount of data
(D) to retrieve images through internet
41. The working definition of imaging includes the following except:
(A) to give energy input that passes through the object
(B) to induce interaction between the input energy and the matters inside
the object.
(C) to record and decode the output signal
(D) to save the images for data archiving
42. How many kilobytes(KB) for a 2D binary image with 128 x 128 matrix size?
(A) 16.4 KB
(B) 32.8 KB
(C) 65.5 KB
(D) 131 KB
43. The 'image' includes the following important aspects except:
(A) a story
(B) a mental representation
(C) a theory or model
(D) a physical appearance
44. The information of medical images can be extracted from the following
procedure:
(A) mathematical modeling
(B) statistical inference
(C) data mining
(D) all of the above
45. In the era of post-genomics, the role of medical imageing is:
(A) provide endophenotype
(B) provide imaging biomarker
(C) early diagnosis on molecular or cellular level
(D) all of the above
46. Which of the following is not correct?
(A) Because of the improvement in sanitation and vaccination, epidemic of
infectious diseases is now a lesser threat to human health.
(B) In the last century, doctors used many medicines to treat patients
without knowing the detailed molecular mechanisms of drug actions.
(C) With the advance of newer technology and tighter regulation on human
clinical trials, it is now more common that new drugs are much more
'well' understood before they are introduced to the market.
(D) With new knowledge and technology in biomedicine, the old art of
history taking and physical examination is no longer important for a
doctor in clinical practice.
47. Which of the following is not correct?
(A) The discovery of restriction enzymes makes us capable of manipulating a
gene in our laboratory.
(B) The cell-based therapy, for example stem cell therapy, just like gene
therapy is now widely used in clinical therapy.
(C) Polymerase chain reaction enables us to handle a gene in a very small
quantity.
(D) Micro-array technology is mostly used to monitor the expression of
thousands of genes simultaneously.
48. Which of the following description about information technology is wrong?
(A) It is now essential for biomedical research and practice.
(B) It helps doctors to find new development in treatment for patients
through internet.
(C) It is not helpful for data analysis for laboratory researchers.
(D) For copyright issue, there are still obstacles for information sharing.
三、問答題：（10分）
請簡述基因微陣列之基本原理及可能之基礎臨床應用。
四、簡答題：（21分）
1. 請舉3種 high throughput technologies。（3分）
2. 請說明癌症於不同時期（different stages）時期生物標記之功能。（3分）
3. 如何鑑定蛋白質身份。（3分）
4. 電子病歷所面對的挑戰包含有？（2分）
5. 請說明『病歷』的主要用途與目的。（2分）
6. 請列出四項常用之國際醫療資訊標準名稱。（2分）
7. 請解釋說明衛生署本年度推動電子病歷MVC概念之分別重點與適用對象。（2分）
8. 請解釋電子病歷與電子病歷系統之差異性。（2分）
9. 若您身為某醫院之院長，請問將如何評估電子病歷的推動？（2分）
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