[醫概] 陳志榮考古題~找到的

看板CSMU-MED95作者tonyisa01047 (龘楓(龍三)最愛倉木麻衣)時間16年前 (2009/04/19 01:13)推噓15(15推 0噓 0→)

留言15則, 15人參與討論串1/1

以下是學長姐的資料至於詳解我也不知道對不對提供給大家看看 PS.這學期怎麼頗有上學期期末考的FU？　書都快念不完了啦= = 念完又忘了囧 ========================正題開始============================= 1. A 35-year-old man has an enlarged mass in his right neck. Biopsy of the mass shows granulomatous inflammation in soft tissue. Which of the following cells most likely mediates the histological changes？ (A)IgE secreting B lymphocytes (B) IgA secreting B lymphocytes (C)Natural killer cells (D)CD4+ T lymphocyte (E)CD8+ T lymphocyte Ans. (D)【見陳志榮Immune Disease (1)共筆P.13】。肉牙腫發炎屬於第四型過敏反應中的遲發型過敏，以CD4+ T細胞為主，CD4+ T細胞可以活化macrophage而形成類上皮細胞和giant cell；或分泌許多cytokine造成發炎和乾酪性壞死。 2. Which of the following cells is most likely involved in a patient with skin rash and itching after having shrimps in his dinner？(A)Mast cells (B)Natural killer cells (C)Macrophages (D)Langerhans cell (E)Follicular dendritic cells Ans. (A)【見陳志榮Immune Disease (1)共筆P.8】。患者在吃完蝦子就產生過敏症狀，這是第一型過敏反應（Immediate Type）。和第一型過敏反應相關的細胞是肥大細胞；此外basophil和eosinophil和B cell也可參與其晚期反應。 3. A 30-year-old woman has had fever and arthralgia for 2 weeks. On physical examination, she has an erythematosus skin rash on her face. Laboratory tests are positive for ANA at 1:1600 and anti-double-stranded DNA autoantibodies at 1:3200. Pancytopenia is also present. Which hypersensitivity mechanism(s) is (are) mediated for her pancytopenia? (A) Type I hypersensitivity (B) Type II hypersensitivity (C) Type III hypersensitivity (D) Type IV hypersensitivity (E) Types II and III hypersensitivity Ans. (B)（抱歉BC不太確定，查網路應該是B）【見陳志榮Immune Disease (2)共筆P.7】。（1）首先由1.關節痛（arthralgia） 2.臉部紅斑（erythematosus skin rash on face ） 3.抗核抗體（ANA）4.免疫失常，出現anti-double-stranded DNA 5.有血液疾病泛血球減少（pancytopenia）可診斷為SLE。（2） SLE的病發機轉包括兩種： 1. Type III hypersensitivity：免疫複合體 (DNA跟抗核抗體的結合體)所引發的發炎反應 (或稱)是導致多數臟器，尤其是腎臟，受損的主要原因。雖不清楚抗核抗體是不是會進入細胞，但如果細胞核暴露在外時（如細胞死亡），抗核抗體就會與之結合，並影響染色質的功能。 2. Type II hypersensitivity：此外，也有些針對紅血球、白血球及血小板的自體抗體會導致這些細胞的折損而引起發炎反應。 4. A 42-year-old man develops difficulty breathing after a sting by虎頭蜂. Marked urticaria and edema of the hand that was stung are found. Which of the followings is most likely mediates the reaction? (A) IgA (B) IgD (C) IgE (D) IgG (E) IgM Ans. (C)【見陳志榮Immune Disease (1)共筆P.8】。蚊蟲叮咬屬於第一型過敏反應的過敏原，跟它相關的抗體是IgE，常見叮咬包括下列兩大類： 1.蜜蜂、黃蜂、虎頭蜂、火蟻會螫人引起全身性血管過敏性休克。2.蚊子、鹿蠅、蝨等會咬人，但大多為局部性血管反應。另外如果是蛇（非蟲）咬到而神經麻痺掉，應該就不算是過敏了.. 5. A 35-year-old man with chronic renal failure received a renal transplant five years ago. For last few years, he had only minor episodes of rejection that were controlled with immunosuppressive therapy. In the past 6 months, he has had increased serum creatinine and urea nitrogen levels. No proteinuria or leukocyte is noted in his urine. CT scan shows that the allograft is reduced in size. Which of the following immunologic processes most likely accounts for these findings? (A) Granulomatous vasculitis (B) Complement-mediated cell lysis (C) Antibody-mediated vasculitis (D) CD8+ lymphocyte-mediated cell necrosis (E) Vascular intimal fibrosis Ans. (E)（抱歉不是很確定..）【見陳志榮Immune Disease (1)共筆P.16】。（E）根據患者在移植數年後才有上述反應，可判斷是慢性排斥chronic rejection，此排斥的特徵有：（網路某篇論文）namely glomerular basement membrane duplication (chronic transplant glomerulopathy) and/or arterial intimal fibrosis（和E選項相同，所以就選了） with intimal mononuclear cell infiltration, showed PTC C4d staining. 造成慢性排斥的機轉尚未明瞭..可能是老師說的Indirect T cell-mediated，或是趙俊*說的與抗體有關.. （A）很多病如Wegener's granulomatosis (granulomatous vasculitis)，主要是T cells are present.. （B）補體反應主要見於Type II和 III hypersensitivity。和慢性過敏比較無關.. （C）雖說趙俊*說chronic rejection與抗體有關，不過Antibody-mediated vasculitis 通常是指急性過敏（相關資料不是很明確..） ※綜合講義網路和趙俊*：與B cell有關的排斥（參考一下囉 ^^）（1）超急性數分鐘~數小時體內已有抗體（2）急性 5天~數月由Th2、B引起的Antibody-mediated vasculitis（所以不能選C選項）。另外也可參考老師的講義P5也有寫acute humoral rejection ※通常急性排斥的主角是細胞型免疫喔.. （3）慢性數年~數十年機轉未明，可能與T4（CD4+ T細胞）或B細胞有關，特徵如E選項，有intimal fibrosis （D）又Indirect T cell-mediated的免疫反應通常是CD4+ T細胞參與，所以(D)錯.. 6. A 25-year-old male received peripheral stem cell transplantation for acute leukemia two months ago has developed an extensive scaling rash since last week. A skin biopsy specimen shows upper dermal lymphocytic infiltrates and keratinocyte apoptosis. He also has jaundice. Which of the following cells is most involved in his present disease? (A) CD4+ T lymphocyte (B) CD8+ T lymphocyte (C) IgE-secreting B lymphocyte (D) Macrophage (E) Langerhans cell Ans. (A)（抱歉不是很確定）【2/26陳志榮講義P.6中Late problems】老師只有說關於PBSC (peripheral blood stem cell) 移植早期（weeks之內），有皮膚淋巴腺浸潤，就是immunocomptent T cell，網路查有一篇Peripheral blood stem cell allograft rejection mediated by CD4+ T lymphocytes recognizing a single mismatch at HLA-DP1*0901，另外也有一篇寫Total T cell, CD4+T cells and CD56+NK cell reconstitution were improved in alloBCT group vs alloBMT group. CD4+/CD8+ ratio evolution were improved in alloBCT group vs alloBMT and autoBCT groups. These results confirm that rapid immune recovery is associated with allogeneic blood stem cell transplantation.所以應該選A吧，不過其實CD4或CD8好像都有關係。另外如果是後期（3~18個月），老師就有寫影響主要是 helper T cell = CD4+ T lymphocyte。 7. After one hour of a mismatched blood transfusion, a 54-year-old male patient becomes tachycardic and hypotensive and passes pink-colored urine. Which of the followings is the most possible mediated mechanism? (A) Complement-mediated lysis of RBCs (B) Mast cell degranulation (C) Immune complex deposition in glomeruli (D) Release of leukotrienes into circulation (E) Activation of macrophages Ans. (A) 輸血錯誤會產生超急性的排斥，造成RBC被抗體-補體路徑溶解，故尿液呈粉紅 8. A 40-year-old man has been infected with HIV for the last 10 years. In recent one year, he has had several episodes of oral candidiasis and body weight loss in past 6 months. He also has skin lesions that were been diagnosed as Kaposi sarcoma. Which of the following types of cell is most depleted in his lymph nodes? (A) Neutrophil (B) Follicular dendritic cell (C) Macrophage (D) CD8+ lymphocyte (E) CD4+ lymphocyte Ans. (E) 見【講義2/26陳志榮特別演講講義P.10 AIDS部份第六點】 HIV主要使CD4+ T lymphocyte減少 9. Which is the characteristic histological change of type III hypersensitivity? (A) Marked eosinophilic infiltration (B) Lymphocytic infiltration (C) Acute necrotizing vasculitis (D) Granuloma formation (E) Thrombus formation Ans. (C) 2/26陳志榮特別演講講義P.4第六行，微觀病變可見IC沉積引起急性壞死性血管炎 10. A 2-year-old boy had continuous infections since he was 6 months old. These infections have included otitis media, pneumonia, and skin infections and were mainly caused by different bacteria. He had an older brother with a similar condition died because of severe infections. The boy's sister and both parents are normal. Which of the following laboratory findings would most likely be seen in this boy? (A) Lower level of IgA (B) Decreased complement C3 (C) Positive ANA test result (D) Markedly decreased immunoglobulin (E) Elevated IgM level Ans. (D)（抱歉不是很確定）【見陳志榮講義P.9下SCID部分】由題幹敘述可知此病盛行於男童，推知是遺傳X顯或隱性的疾病，且影響免疫系統甚鉅，故不斷受到感染，再加上6月大發病、死亡率高，推論符合的疾病主要可能有兩種： 1.X-linked agammaglobulinemia（體液免疫不全，3月後發病） 2.SCID（有細胞免疫和體液免疫不全的情形，主要3~6月大時發病）。而這兩種病在D選項都成立。選項BCE老師講義好像都沒講到。不選A是因為應該單一缺IgA的話，死亡率和症狀都比較不嚴重，且皮膚比較沒病變。 -- 倉木麻衣新作品情報 2009 / 06 / 10 第32張單曲「Beautiful」發售 CM：化妝品廣告印象曲　　　　　　　　CD + DVD 2009 / 07 / 01 第二張精選輯「Mai Kuraki BEST "MERRY MUSIC!"」發售 2CD -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 123.240.37.176

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