既然来不及印, 那我打一打好了..:Q 89 学年度第二学期临床病理讨论会期末测验 ** 请於下列题目中自选五题作答 ** 每一试题请用一张答案卷，并请於答案卷右上角注明出题教师 ˙孙家栋医师 (20%) A 48-year-old male patient is a chronic alcoholic for 20 years and have known to be a HBV carrier for 10+ years. This time he presented general malaise, poor appetite, and abdominal discomfort 2 weeks before admission. So he took some herb drugs for 6 days. However, icteric sclera and tea-colored urine developed without improvement of symptoms and signs. He visited a local hospital where laboratory data revealed elevated hepatic enzyme (GOT/GPT=1040/1405 U/L), prolonged PT, elevated serum ammonia (111 umole/l) and high serum bilirubin (bil T/D: 19.3/11.1 mg/dl). Hepatitis marker study revealed HbsAg (+), HbeAg (-), a-Hbe (+) and a-HCV (-). Image study revealed shrinkage of liver. Please answer the following questions briefly. A) What are your differential diagnosis? B) How to prove the possibility of reactivation of Hepatitis B virus? C) How to handle this patient? D) What is the possible pathological change of the liver? ˙苏益仁医师 (20%) 请描述花莲吴氏夫妇猝死症的可能病因及诊断 ˙林中梧医师 (20%) A 28 y/o male patient presents with orthopnea, dyspnea, and bilateral leg edema of 2 years' duration. Cardiac catheterization shows severe stenosis of the coronary arteries. Angiogram shows extensive occlusion of peripheral arteries. Please list 3 most probable causes for the arterial occlusion. For each one, suggest a diagnostic test, pathological or clinical finding to support your diagnosis. ˙彭晔医师 (20%) 1. Please describe the followings: (16%) A: The possible etiology of hemophagocytic syndrome. B: Difficulties in its diagnosis C: Diagnostic guidelines 2. Please describe the differential diagnosis of aplastic anemia and hemophagocytic syndrome based on H & E sections of the bone marrow. (4%) ˙吴振都医师 (20%) 1. Please describe the clinicopathologic findings in necrotizing enterocolitis briefly. 2. Please describe the relationship between necrotizing enterocolitis and parenteral nutrition associated cholestasis. ˙吴木荣医师 (20%) A 51-year-old woman was a case of nasopharyngeal carcinoma (anaplastic epidermoid carcinoma) diagnosed at CGMH in 1981. Radiotherapy was given (NP: 7000cGy, neck: 6000cGy in 32 fractions) from Aug. 31 to Oct. 24, 1981 at NTUH. No recurrent sign was noted during regular OPD follow-ip. From 1986 to 1999, she had osteoradionecrosis (ORN) of left maxilla, nasal synechia, trismus, left total deafness (PTA>110dB) and right hearing impairment (PTA=68dB) with hearing aids. Later, she had deep neck infection with 2 fistulae in left side of neck. Tracheostomy and gastrostomy were performed. There were cachexia, malnutrition, anemia, thrombocytopenia, and persisted electrolytes imbalance due to GI upset with occasional diarrhea and poor digestion of feeding. Despite intravenous antibiotics and intensive wound care, she had high fever and constant pus discharge from left side of neck, oral cavity and bilateral ears. CT scan showed suspicious recurrence, but her serial nasopharyngeal biopsies failed to prove it. Her consciousness and vital signs dropped down gradually and more pus gushed out from left side of wound on neck and high fever flared up. She expired and kindly donated her body for pathological autopsy. An autopsy was performed two days later. After reading above statement, please answer the following questions: Q1: What are the major complications of a patient with NPC after radiotherapy? Q2: Do you think this woman have recurrent nasopharyngeal cancer? Why and how to make your treatment plans? Q3: What are your differential diagnoses of a recurrent primary and a second primary malignancy of nasopharynx? Q4: Which points are your comments after clinicopathological conference? ˙蔡建诚医师 1. 关於婴儿黄疸的原因，除了胆道闭锁（biliary atresia）、新生儿肝炎（neonatal hepatitis）、进行性家族性肝内胆汁郁滞（PFIC）以外，请再列举任一项肝胆疾病 的原因。(2%) 2. 关於第一型进行性家族性肝内胆汁郁滞（type I PFIC）︰ a) 分子生物学上如何诊断？(2%) b) 生化检查时，γ-GT 数值如何？(2%) c) 其肝脏组织做电子显微镜检查，可看到何种特殊病变？(2%) 3. 一个五岁小孩接受肝脏移植手术，除了排斥（急性与慢性）与感染（各种微生物）以 外，请再列举任四项术後可能的合并症（complication）。(8%，不要多写) 4. 一个多重器官衰竭、休克致死的病人捐做解剖，以下器官常呈现何种病变？ a) 肝脏 (2%) b) 肺脏 (1%) c) 肾脏 (1%) --

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