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弘光科技大學
95學年度營 養醫學研 究 所 考試入 學 筆試試題 及 答案卷
考試科目：內科學
准考證號碼：□□□□□□
注意：
1.請核對考試科目是否相符。
2.請核對試卷上之准考證號與准考證及座位上之准考證號碼是否相符。
3.本試卷題型為單選之選擇題共30題，每題2分；申論題兩題，每題20分；共計100分。
4.請將答案填寫於規定之範圍內。
1.
A 56-year-old man presents to your office for evaluation. For the past 6 months, the patient has been experiencing fatigue and mild dyspnea on
exertion. He has no pertinent medical history. He denies having chest pain, orthopnea, edema, fever or chill, but he does state that he has developed
intermittent numbness and tingling of his distal extremities. Physical examination is significant only for conjunctival pallor and decreased vibratory
sensation in both feet. CBC reveals normal WBC and platelet counts, a hematocrit of 28%, and a mean corpuscular volume of 115 fL. Blood smear
is significant for multiple hypersegmented neutrophils. Alcohol screening by history is negative. The patient takes no medications, and he denies
having any risk factor for HIV infection. Further laboratory testing reveals normal liver function, a low reticulocyte count, and normal serum
vitamin B12 and RBC folate levels.
Which of the following statements regarding the necessity of further testing for vitamin B12 deficiency is true?
A. Assuming the serum vitamin B12 test has a low sensitivity and high specificity, no further testing is needed
B. Assuming the serum vitamin B12 test has a low sensitivity and low specificity, no further testing is needed
C. Assuming the serum vitamin B12 test is 100% specific, no further testing is needed
D. Considering this patient’s high pretest probability for vitamin B12 deficiency and knowing that the vitamin B12 assay is not perfect (i.e., that it has a
sensitivity of less than 100%), further testing is required
2. A patient in your clinic states that her entire family is using acupuncture for everything that ails them.
Which of the following statements regarding the practice of acupuncture is true?
A. Clear evidence supports the use of acupuncture for chemotherapy-induced vomiting
B. There are essentially no adverse events associated with acupuncture
C. Acupuncture was proven ineffective for postoperative vomiting
D. Acupuncture likely has a role in smoking cessation
E. Acupuncture works by stimulating nerves at the needle site
3. One of your patients tells you that she attended a seminar on the use of mind-body interventions to treat various conditions. She has been using
various methods to overcome problems with asthma, anxiety, and substance abuse.
Which of the following statements is false regarding mind-body interventions?
A. The success of hypnotherapy depends on patient attitude toward hypnosis
B. Biofeedback is a relaxation technique in which the patient continually subjectively assesses his or her level of relaxation and makes appropriate
adjustments
C. Aromatherapy involves the use of essential oils to induce a relaxation response
D. Mind-body interventions likely affect hormonal balance in a positive manner
4. A 63-year-old man presents to your clinic for an initial evaluation. He has a coronary artery disease, congestive heart failure, atrial fibrillation,
benign prostatic hyperplasia, and erectile dysfunction. His current medical regimen includes hydrochlorothiazide, metoprolol, enalapril, digoxin,
coumarin, and terazosin. During the visit, the patient pulls out a bag of vitamins and herbal supplements that he recently began taking. He hands you
several Internet printouts regarding the supplements and asks your advice.
Which of the following statements about dietary supplements is true?
A. misidentification of plant species, contamination with heavy metals and addition of pharmaceutical agents have all been checked and are unlikely to
happen in the case of dietary supplements
B. Because they are natural products, dietary supplements are uniformly safe, with no significant drug-drug interactions
C. The dietary-supplement industry has little incentive for research because natural substances cannot be patented
D. The US Food and Drug Administration (USFDA) regulates dietary supplements under the same guidelines as pharmaceuticals
5. A 60-year-old man presents with progressive symmetrical lower extremity edema.
Which of the following findings would be inconsistent with a diagnosis of right-sided heart failure?
A. The Kussmaul sign
B. Prolonged prothrombin time
C. Diarrhea
D. Elevated Bilirubin level
E. Pulsus paradoxus
6. A 72-year-old woman comes to see you to establish care, after her previous physician retired. Her medical history is significant for diet-controlled
diabetes and a myocardial infarction. She is taking aspirin, simvastatin, and amlodipine. On examination, her blood pressure is 170/95 mm Hg. She has a
S4 gallop and 1+ pretibial edema.
What should be the target blood pressure in the long term for this patient?
A. ＜150/90 mm Hg
B. ＜140/90 mm Hg
C. ＜130/85 mm Hg
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D. ＜120/70 mm Hg
7.
A 57-year-old man presents to the hospital with generalized weakness, weight loss, and worsening constipation. He is found to be profoundly
anemic. His stools test positive for occult blood. A colonoscopy is performed, and a large intraluminal mass is seen. Results of biopsy indicate
adenocarcinoma of the colon.
Which of the following statements regarding p53 is false?
A. p53 plays a critical role in the maintenance of genomic integrity and is known as the “guardian of the genome”
B. Genetic injuries trigger the stabilization and activation of p53 protein
C. p53 protein functions by repairing DNA molecules
D. High levels of p53 protein in tumor specimens are commonly taken as evidence of a mutation in p53
8.
A 37-year-old man is diagnosed with Hodgkin lymphoma after presenting with fever and lymphadenopathy. The patient is treated with a
combination of doxorubicin, bleomycin, vincristine, and dacarbazine. After 3 days of treatment, the patient complains of mouth pain and diarrhea.
His physical examination shows erythematous buccal mucosa.
Which of the following is the most likely pathogenesis of these complications?
A. Progression of his lymphoma
B. Vitamin B12 deficiency
C. Clostridium difficile colitis
D. A side effect of the chemotherapy
9.
For the past several months, a 50-year-old man has been experiencing upper abdominal discomfort, nausea and bloating; these symptoms are worse
exclusively after eating. You diagnose the patient with dyspepsia.
Which of the following is NOT one of the alarm features associated with dyspepsia caused by ulcers or cancer?
A. Dysphagia
B. Emesis
C. Weight loss
D. Bleeding
10. A 34-year-old woman undergoes chemotherapy for advanced-stage breast cancer. As expected, she develops pancytopenia.
Which cell line would you expect to be the last to recover in this patient?
A. Eosinophils
B. Platelets
C. Basophils
D. Monocytes
E. RBCs
11. A 43-year-old man presents to your clinic complaining of fatigue and paresthesias. He is a vegetarian and does not take a multivitamin. His
examination reveals pallor, an absence of hepatosplenomegaly, normal muscle strength throughout, and loss of position sensation and vibratory
sensation distally. A CBC reveals anemia, with a mean corpuscular volume (MCV) of 106 fL. His WBC, platelet count, and serum chemistries are
normal. He has had no toxic exposures and is taking no medications.
Which of the following statements about megaloblastic anemia is false?
A. Absorption of cobalamin in the small intestine is dependent on proteins produced in the mouth and stomach
B. Megaloblastic erythropoiesis is characterized by defective DNA synthesis and arrest at the G2 phase, with impaired maturation and a buildup of
cells that do not synthesize DNA and that contain anomalous DNA
C. In most patients with severe cobalamin deficiency, the neurologic examination is normal
D. Cobalamin deficiency is treated with parenteral cobalamin therapy
12. An 86-year-old man visits your clinic for routine follow-up. Upon questioning, the patient admits to worsening dyspnea on exertion and generalized
fatigue. He denies having fever, chills, cough, dysuria, blood loss or weight loss. Routine laboratory studies reveal a hemoglobin concentration of
8.0 g/dL, a hematocrit of 24%, and a mean cell volume of 70 fL. The patient denies eating nonfood substances but does admit to craving and eating
large amounts of ice daily. The patient’s stool is positive for occult blood by guaiac testing.
For this patient, which of the following statements regarding iron deficiency anemia is true?
A. In men and postmenopausal women, a pica and a poor supply of dietary iron are the most common causes of iron deficiency anemia
B. Pagophagia, or pica with ice, is a symptom that is believed to be specific for iron deficiency
C. Measurement of the serum iron concentration is the most useful test in the detection of iron deficiency
D. The preferred method of iron replacement for this patient is parenteral therapy
13. Which of the following statements regarding megaloblastic anemia caused by folic acid deficiency is false?
A. Serum folic acid levels more accurately reflect tissue stores than do red blood cell folic acid levels
B. Folic acid deficiency can be differentiated from cobalamin deficiency by measuring methylmalonic acid and homocysteine levels; both are elevated
in cobalamin deficiency, but only homocysteine is elevated in folic acid deficiency
C. Megaloblastic anemia caused by folic acid deficiency can be masked by concurrent iron deficiency anemia, but hypersegmented polymorphonuclear
cells (PMNs) should still be present on the peripheral smear
D. Folinic acid can be used to treat patients with megaloblastosis and bone marrow suppression associated with the use of methotrexate
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14. A 55-year-old man presents to your clinic complaining of swollen breasts. His symptoms started 3 or 4 months ago, when he noticed tenderness
and swelling in both breasts. His medical history includes congestive heart failure and hypertension. His medications are lisinopril, metoprolol,
furosemide and spironolactone. Review of systems is positive only for occasional dyspnea on exertion. Physical examination shows bilateral
gynecomastia in the periareolar area, with some tenderness to palpation. Testicular examination is normal.
Which of the following would be the best step to take next in the evaluation and management of this patient?
A. Liver ultrasound
B. Mammography
C. Testicular ultrasound
D. Cessation of spironolactone
15. A 66-year-old woman presents to a clinic with muscle spasms. She complains that for the past 2 days she has had muscle spasms in her hands,
arms, and legs. She has a medical history of cervical Hodgkin lymphoma, which was treated with radiation. She does not take any medications or
vitamins. On physical examination, the Trousseau sign is positive. Her calcium level is 6.8 mg/dL; the albumin level is normal.
On the basis of this patient’s history, what is the most likely diagnosis, and what should be the treatment?
A. Hypoparathyroidism secondary to radiation therapy; start PTH injections
B. Vitamin D deficiency secondary to poor intake and lack of sunlight; start calcitriol
C. Vitamin D deficiency secondary to poor intake and lack of sunlight; start cholecalciferol
D. Hypoparathyroidism secondary to radiation therapy; start calcium and calcitriol
16. A 42-year-old woman comes to your office to establish primary care. She reports no previous medical history except uterine myomata which she
underwent a vaginal hysterectomy. She currently takes no medications. The results of physical examination are as follows: blood pressure, 131/81 mm
Hg; heart rate, 87 beats/min; weight 82 kg; height 171 cm. Other than the fact that she appears obese, there are no pertinent findings on physical
examination. You are concerned with the long-term implications related to her being overweight.
On the basis of the available data, what is the calculate body mass index (BMI) for this patient?
A. 28
B. 24
C. 32
D. 34
17.
A 35-year-old woman comes to your office requesting your opinion on how to lose weight. She has no known complications or associated
comorbidities secondary to obesity. She read on the Internet that approaches to weight loss are based on the calculation of BMI. She tells you that
because her BMI is 33, medical therapy is indicated. Her sister has had great success taking orlistat, having lost 10 kg without having any
significant side effects.
Which of the following statements regarding the use of orlistat therapy in this patient is true?
A. Orlistat is generally safe and well tolerated by most patients; the patient should be started on orlistat therapy in conjunction with a diet-and-exercise
program
B. The patient should be started on orlistat therapy; there is no need to prescribe
C. Orlistat is generally safe, but a significant number of patients experience side effects; the patient should be started on orlistat therapy in conjunction
with a diet-and-exercise program
D. Orlistat is poorly tolerated by most patients and has life-threatening side effects
18.
A.
B.
C.
D.
診斷缺鐵性貧血最有用的檢驗項目為：
serum iron
TIBC
serum ferritin
hematocrit
19.
A.
B.
C.
D.
根據行政院衛生署最新的統計，糖尿病為台灣十大死亡原因的第幾位？
第二位
第四位
第六位
第八位
20.
A.
B.
C.
D.
有關COX-2何者為非：
病理誘生性酵素
正常情況下，組織細胞內均可發現
NSAIDs的抗發炎、鎮痛效果，被認為是抑制COX-2的生合成
某些消化系癌症有高表現量COX-2
21.
A.
B.
C.
D.
服用下列藥物會導致uric acid不易排除而形成hyperuricemia，何者除外？
benzbromarone
thiazide與loop類利尿劑
低劑量阿斯匹靈 (aspirin)
某些抗結核藥物，如ethambutol、pyrazinamide
22.
A.
B.
C.
D.
下列何者為鋅缺乏的症狀？
營養不良、腹瀉、味覺減退
免疫功能下降、性荷爾蒙功能低下
皮膚炎、禿頭、傷口癒合慢
以上皆是
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23. 下列敘述何者為是？
A. 鋅是人體的必須微量元素，身體內大概含有2-3克的鋅，在血漿中的鋅是由白蛋白及球蛋白攜帶
B. 腸病變性肢端皮膚炎（Acrodermatitis enteropathica）是一種體隱性的疾病，為調控鋅吸收的基因突變，使得患者無法吸收食物中的鋅，通
常在孩童時期就死亡
C. 鋅調控並影響身體重要的賀爾蒙及200種以上的金屬酶（metalloenzymes）
D. 以上皆是
24. 美國糖尿病學會提出目前Hyperosmolar Hyperglycemic State (HHS) 的診斷標準，下列敘述何者為非？
A. 血漿血糖大於600 mg/dL
B. 血清有效滲透壓大於320 mOsm/ kgH2O
C. 允許有輕度的酮酸中毒
D. Glasgow coma scale < 8
25.
A.
B.
C.
D.
牙籤造成胃腸道損傷最常見發生於：
Esophagus
Stomach
Duodenum
Rectum
26. A 64-year-old man comes to your clinic for a routine visit. He has a history of myocardial infarction, which was diagnosed 1 year ago. Since that
time, he has been asymptomatic, and he has been taking all his medications and following an exercise program. His physical examination is
unremarkable. He has been getting some information on the internet about the use of omega-3 polyunsaturated fatty acids as a part of a cardioprotective
diet.
Which of the following statements is most accurate concerning the use of omega-3 fatty acids?
A. Consumption of omega-3 polyunsaturated fatty acids has been shown to decrease the incidence of recurrent myocardial infarctions
B. Omega-3 polyunsaturated fatty acids have been shown to decrease low-density lipoprotein (LDL) cholesterol levels
C. Consumption of omega-3 polyunsaturated fatty acids is inversely related to the incidence of atherosclerosis and the risk of sudden death and stroke
D. Omega-3 polyunsaturated fatty acids have been shown to elevate triglyceride levels
27. A 52-year-old woman comes to your clinic to establish primary care. She has not seen a doctor in years. She describes herself as being very
healthy. She has no significant medical history, nor has she ever used tobacco or ethanol. She underwent menopause 3 years ago. Her physical
examination is unremarkable. You ask about her dietary habits and find that the amount of fat that she is eating is in accordance with the AHA
recommendations for healthy adults. She does not drink milk. Results of routine laboratory testing are within normal limits.
Which of the following additional dietary recommendations would be appropriate for this patient?
A. Take supplements of calcium, vitamin D, and vitamin A
B. Take supplements of calcium and vitamin D, and restrict the amount of sodium to less than 2,400 mg a day
C. Take supplements of iron, vitamin D, and vitamin A
D. Continue with the present diet
28. A 38-year-old man with stage C CHF remains symptomatic in spite of diuretic therapy. You are considering adding a second and perhaps even a
third agent to his regimen.
Which of the following pharmacologic agents used in the management of heart failure lacks trial data indicating a mortality benefit and does not prevent
maladaptive ventricular remodeling?
A. ACE inhibitors or angiotensin receptor blockers (ARBs)
B. Spironolactone
C. Beta blockers
D. Digoxin
29. A 64-year-old woman presents to the emergency department with abdominal pain, nausea, and vomiting of 3 days’ duration. The pain is epigastric
and radiates to her back. She takes no medications. The physical examination reveals a patient with mild obesity; the patient’s temperature is 37.9℃, and
epigastric tenderness is present. An abdominal CT scan with contrast shows pancreatitis with enhancement of the entire gland and a 5 cm collection of
fluid next to the pancreas.
Which of the following is the most accurate diagnosis for this patient?
A. Interstitial pancreatitis with an acute fluid collection
B. Interstitial pancreatitis with an uncomplicated pseudocyst
C. Necrotizing pancreatitis with a peripancreatic phlegmon
D. Interstitial pancreatitis with a pancreatic abscess
30. A 74-year-old man is transported to the emergency department by ambulance for evaluation of cough, dyspnea, and altered mental status. Upon
arrival, the patient is noted to be minimally responsive. Results of physical examination are as follows: temperature 38.9℃; heart rate 116 beats/min;
blood pressure, 94/62 mm Hg; respiratory rate, 34 breaths/min; and O2 saturation, 72% on 100% O2 with a nonrebreather mask. The patient is intubated
in the emergency department, and mechanical ventilation is initiated. Coarse rhonchi are noted bilaterally. A portable chest x-ray reveals good placement
of the endotracheal tube and lobar consolidation of the right lower lobe. Laboratory data are obtained, including sputum Gram stain and culture and
blood cultures. Empirical antimicrobial therapy is initiated, and the patient is admitted to the medical intensive care unit for further management. The
resident on call inquires about the appropriateness of initiating nutritional support (enteral or parenteral feeds) at the time.
Which of the following statements regarding nutritional support is true?
A. Enteral nutrition is less likely to cause infection than parenteral nutrition
B. Parenteral nutrition has consistently been shown to result in a decrease in mortality, compared with standard care
C. The use of oral supplements in hospitalized elderly patients has been shown to be harmful
D. Parenteral nutrition is the preferred mode nutrition in cancer patients because of its lower incidence of infections
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弘光科技大學
95學年度營 養醫學研 究 所 考試入 學 筆試試題 及 答案卷
考試科目：內科學
准考證號碼：□□□□□□
注意：
1.請核對考試科目是否相符。
2.請核對試卷上之准考證號與准考證及座位上之准考證號碼是否相符。
3.本試卷題型為單選之選擇題共30題，每題2分；申論題兩題，每題20分；共計100分。
4.請將答案填寫於規定之範圍內。
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申論題：
1. What causes nausea and vomiting? Please describe the pathways and neurotransmitters involved in nausea and vomiting.
(20%)
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2.
Anemia of chronic disease. (20%)
※作答時勿超過此線
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