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(A) 4 3 (B) 2 2 (C) 10 7 (D) 30 21 : A:75% B:100% C:70% D:70% D 6. 58 (A) (B) (C) (D) : C 7. ( TRM ) (A) ( autonomy ) (B) ( support ) (C) ( monitoring ) (D) ( communication ) : 2008 TRM 8. XX () (A) (B) (C) (D) 9. Penicillin test ( anaphylactic shock ) (A) (B) (C) (D) :

~~~ 10. (A) ( ) (B) () (C) (D) ( ) : 11. 1 2 3 (A) 1+3 (B) 2+3 (C) 1 (D) 2 :2011 12.

(A) (B) (C) (D) : : n disclosure capacity voluntariness 13. ( DNR ) ( ) IC (A) (B) (C) (D) : 6 14. (A) 1993 (1995 )(B) (C) ()(D) ( ) : 15. (environmental tobacco smoke; ETS ) (A) ETS ( main-stream smoke ) ( side-stream ) (B) (C) (D)

: 15 85 secondhand tobacco smoke, SHS 16. () (A) 45 ~ 60 (B) 40 (50~69 2 ) (C) ( 1 40 1 ) (D) 40 PSA ( PSA PSA ) : 45 70 40 45 2 1 --- () 30 1 () 30 2 1 () 50-69 2 1 () 17. (A) (B) (C) (D) : 90 18. (A) propranolol (beta-blocker)(B) digitalis(digoxin) (C) amlodipine () (D) hydralazine : D (direct vasodilator)

19. ( tactile fremitus ) ( dullness ) (A) (B) (C) (D) : : ; : ; : 20. ( Hypertrophic cardiomyopathy ) () ( systolic murmur ) Valsalva maneuver Squatting ( ) (A) Valsalva maneuver Squatting (B) Valsalva maneuver Squatting (C) Valsalva maneuver Squatting (D) Valsalva maneuver Squatting : A~~~ C valsalva (strain phase) (squatting) 21. S1 S2 (A) (B) (C) (D) : ( S1 S2 ): MR,TR,AS,PS,VSD ; AR ( S2 S1 ) 22. 70 (A) () (B) (C) (D) : 1.: 2.: 3. : riskbenefit analysis the principle of beneficence1. :

2.: aximize individual welfare maximize net welfare 3. 23. ( straight leg raising test, SLRT ) (A) Bragards test () (B) Lasegues test () (C) (D) SLRT L3 : L3 24. ( Guyon tunnel syndrome ) (A) (B) (C) ( thenar ) (carpal tunnel syndrome) (D) : ( thenar ) carpal tunnel syndrome 25. 65 (A) (B) (=> 94% 60 () ) (C) (D) () : 2006 10 Gardasil Cervarix 926 6 11 18 16 1025 16 31 6 18 45 3 0 6 2 0 6 6 1

26. (A) 10 (B) 15 (C) (D) HIV-1 Zidovudine ( AZT ) :

15 24-36 http://www.tsim.org.tw/journal/jour12-3/P12_121.PDF http://www.ganoderma.org.tw/mrf08/nazu/hakou29.htm 27. ( finger-to-nose ) (A) ( stereognostic function ) ~ (B) ( baroreceptor reflex function )~ (C) ( coordination function ) (D) ( sensory-motor function ) : ~~finger-to-nose~ ( coordination function ) 28. 40 2008 2010 GOT ( AST ) GPT ( ALT ) B HBsAganti-HBs anti-HBc IgG and IgM antibody B B (A) 3 B HBsAg Anti-HBs() (B) (C) (D) B : Anti-HBcB IgM IgG IgM IgG IgGHBsAg -B B B HBsAg anti-HBs; HBsAg anti-HBs B B 6 29. 85 (A) Blood urea nitrogen level and urine osmolality(BUN (urine osmolality)(1)

(1)(2)(3)(B) Heart rate and mental status () (C) Serum sodium concentration and serum osmolality (D) Skin turgor and thirsty sensation () : 30. 75 3 30 (A) Amaurosis fugax ( transient visual loss )() (B) Mnires disease() (C) Postural hypotension ( )(D) Transient ischemic attacks : (amaurosis fugax) (88) 7247%38%37% 40. ( septic shock ) 1 SvO2 70 % 2 Hct 30 % 3 CVP 8 ~ 12 mmHg EGDT ( early goal directed therapy ) (A) (B) (C) (D) 3 2 1 :

41. 70 40 65 3 4 ( nutritional deficiency ) (A) Thiamine ( vitamin B1 ) deficiency (B) Niacin ( vitamin B3 ) deficiency (C) Pyridoxine ( vitamin B6 ) deficiency (D) Cyanocobalamin ( vitamin B12 ) deficiency : B12 42. ( parenteral nutrition ) (A) 2 (B) ( peripheral ) amino acids 10 % (C) thrombophlebitis ( subclavian ) (D) ( RQ ) ( = / = 1 = 0.7) : 900 mOsm/L1% 100mOsm/L 43. (A) Bile acid sequestrants and vitamin K deficiency (B) Nonsteroidal anti-inflammatory drugs and iron deficiency (C) Phenytoin and folate deficiency (D) Statins ( HMG-CoA reductase inhibitors ) and vitamin A ( palmitate ) deficiency : Many in the medical profession are beginning to recognize that people who take cholesterol-lowering statin drugs are becoming vitamin D-deficient. Cholesterol is required by the body to synthesize vitamin D and statin drugs are are responsible for eliminating it, leading many to speculate that statin drug users do not have enough cholesterol to process vitamin D. 44. ( ) 1 2

3 4 (A) (B) (C) (D) 4 : http://www.lawtw.com/article.php? template=article_content&area=free_browse&parent_path=,1,4,&job_id=52356& article_category_id=15&article_id=24410 45. 95 ( alcohol-based handrub ) (A) (B) (C) (D) : 60 5 46. (A) ( Hyperpyrexia ) 40 (41.5) (B) Lead-pipe muscle rigidity (C) ( malignant Hyperthermia ) (D) ( Infection ) ( Hyperpyrexia ) ( ICH) : Hyperpyrexia is a fever with an extreme elevation of body temperature greater than or equal to 41.5 C (106.7 F).Such a high temperature is considered a medical emergency as it may indicate a serious underlying condition or lead to significant side effects. The most common cause is an intracranial hemorrhage. The current treatment of choice is the intravenous administration of dantrolene, the only known antidote, discontinuation of triggering agents, and supportive therapy directed at correcting hyperthermia, acidosis, and organ dysfunction.Dantrolene is a muscle relaxant that appears to work directly on the ryanodine receptor to prevent the release of calcium 47. 99 (A) (97-98 )(B) (C) (97-98 ) (D) (97-98 ) : http://www.patientsafety.doh.gov.tw/big5/Content/Content.asp?cid=100 48. [ Na+ ] 120 mEq / L

osmolarity 260 mOsm / L osmolarity 110 mOsm / L [ Na+ ] 25 mEq / L (A) Heart failure (B) Nephrotic syndrome (C) Renal insufficiency (D) Syndrome of inappropriate secretion of antidiuretic hormone :

49. 78 3 Swan-Ganz catheter pulmonary wedge capillary pressure systemic vascular resistance cardiac index (A) ( cardiogenic ) (B) ( hypovolemic ) (PWCP SVR CI ) (C) ( anaphylactic ) (D) ( septic ) : PWCP() SVR CI => 50. ( anaphylaxtic shock ) (A) (B) epinephrine (C) (D) () : (Anaphylaxis) () () 51. 57 60 /30 mmHg (A) NTG () (B) adenosine ( 6 mg ) 1 amp. 2 amp. ( PSVT QRS Tachycardia)

(C) verapamil ( 5 mg ) (D) diazepam ( 10 mg ) 1 / 2 amp. 120 ~ 200 ( ) : EKG Af with RVR ( 60 /30 mmHg) CCB 100J->150J->200J( ) 52. 50 (A) ( cluster headache ) 15~90 (B) ( SAH ) (C) ( migraine ) (D) ( bacterial meningitis ) : 53. (A) (B) (C) (D) : 1200 mg/dl ()(osmotic diuresis) 54. (A) vesicular sound (B) bronchophony (C) vocal resonance (D) hyper-resonance :(consolidation) Bronchophony 55. L4 ~ L5S1 ~ S2 1 ~ 10 7 ~ 8 Radiation therapysteroid morphine IV drip & prn 3 (A) Fentanyl patch (B) morphine IV morphine (C) walker (D) : morphine Fentanyl TTS http://homepage.vghtpe.gov.tw/~tcfund/information/DURO.HTM 56.

(A) (B) (C) ( prn ) (D) : (as need) http://www.mmh.org.tw/taitam/medic/Pharmacy-News/mmhpdata/093-PDF2.pdf 57. ( neuropathic pain ) (A) (transcutaneous electrical nerve stimulation, TENS ) (B) ( nerve block ) (C) ( selective serotonin receptor inhibitor, SSRI ) ( ) (D) meperidine ( demerol ) : Neurogenic PainNeuropathic Pain Sympathetic Pain, Sympathetically Maintained Pain 58. (A) (B) (C) (D) ( ) : 2 http://web2.cc.nctu.edu.tw/~hcsci/hospital/sci/sore.htm 59. (A) (B)

(C) (D) : : 60. 88 (A) (B) (C) (D) 61. 55 (A) (B) (C) (D) : (1996) (1)(2) (3) (4) 62. (A) (B) (C) () (D) 63. 71 (A) (B) (C) 5 (D) : DSM-IV-TR : 2

( ) 64. (A) (B) (C) ( ) (D) 65. (A) ( intrapulmonary shunt ) (B) ( dead space ) (C) ( closing capacity ) (D) ( residual volume ) : Functional residual capacity and residual volume increase with age, resulting in a lower vital capacityThe ventilatory response for a given CO2 production is higher in older adults compared with younger individuals, suggesting a possible increase in dead space ventilationThe closing volume (CV) is the point at which dynamic compression of the airways begins.The CV increases with age, smoking, lung disease, and body position (supine>erect). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695176/ 66. ( Diabetic ketoacidosis ) () (A) (B) (C) (D) : The initial priority in the treatment of diabetic ketoacidosis is the restoration of extracellular fluid volume through the intravenous administration of a normal saline (0.9 percent sodium chloride) solution. This step will restore intravascular volume, decrease counterregulatory hormones and lower the blood glucose level.As a result, insulin sensitivity may be augmented. http://www.aafp.org/afp/990800ap/455.html 67. ( Sepsis ) (A) Ketone acid (B) amino acid(C) Lactate (D) Creatinine : Patients who develop severe sepsis or septic shock commonly demonstrate hyperlactemia and lactic acidosis. The pathophysiology of sepsis associated lactic acidosis has not been well understood. Increased lactate production during

anaerobic and aerobic metabolism and decreased lactate clearance are likely contributors to hyperlactemia. 68. 68 3 84 / 50 mmHg 39 128 / 26 / (A) (B) ( resuscitation) (C) dobutamine (D) dopamine : SIRS urosepsis Begin resuscitation immediately in patients with hypotension or elevated serum lactate >4mmol/L within 6 hours http://www.survivingsepsis.org/About_the_Campaign/Documents/Final %2008%20SSC%20Guidelines.pdf 69. ( metabolic syndrome ) (A) ( nonalcoholic fatty liver disease ) (B) ( polycystic ovarian disease ) (C) ( obstructive sleep apnea ) (D) ( nephrotic syndrome ) : (NAFLD) (metabolic syndrome) 5% 10% 70. ( metabolic syndrome ) () (A) (B) (C) (D) : 5 3 1(: 90cm80cm)2(SBP)130mmHg/ (DBP)85mmHg3(FG)100mg/dl4 (HDL-C)