既然來不及印, 那我打一打好了..:Q 89 學年度第二學期臨床病理討論會期末測驗 ** 請於下列題目中自選五題作答 ** 每一試題請用一張答案卷，並請於答案卷右上角註明出題教師 ˙孫家棟醫師 (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? ˙蘇益仁醫師 (20%) 請描述花蓮吳氏夫婦猝死症的可能病因及診斷 ˙林中梧醫師 (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. ˙彭曄醫師 (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%) ˙吳振都醫師 (20%) 1. Please describe the clinicopathologic findings in necrotizing enterocolitis briefly. 2. Please describe the relationship between necrotizing enterocolitis and parenteral nutrition associated cholestasis. ˙吳木榮醫師 (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? ˙蔡建誠醫師 1. 關於嬰兒黃疸的原因，除了膽道閉鎖（biliary atresia）、新生兒肝炎（neonatal hepatitis）、進行性家族性肝內膽汁鬱滯（PFIC）以外，請再列舉任一項肝膽疾病 的原因。(2%) 2. 關於第一型進行性家族性肝內膽汁鬱滯（type I PFIC）︰ a) 分子生物學上如何診斷？(2%) b) 生化檢查時，γ-GT 數值如何？(2%) c) 其肝臟組織做電子顯微鏡檢查，可看到何種特殊病變？(2%) 3. 一個五歲小孩接受肝臟移植手術，除了排斥（急性與慢性）與感染（各種微生物）以 外，請再列舉任四項術後可能的合併症（complication）。(8%，不要多寫) 4. 一個多重器官衰竭、休克致死的病人捐做解剖，以下器官常呈現何種病變？ a) 肝臟 (2%) b) 肺臟 (1%) c) 腎臟 (1%) --

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