0291 2182
Ԕ ֏ ऽಈ̂छд˛ѐ۞Ӆ˧ᄃᇴ۞҂ྏ̝ޢĂפזֽٺҖᗁྤ ॾĞజӘྤॾĉğ۞ܝ̂ै˘ޢĄ࠹ܫགྷ።ᇴ̂̈҂ྏă၁௫۞ ЧҜĂд˘ޢᙯ˵̙ົѣ͉̂۞યᗟĄ дЊྎྋ̚ĂԧࣇႽณΝଫͽ҂ྏԫμྋඍ۞͞ڱĂ֭ྃ·ϒ ቁٕߏᄱᏴี۞࠹ᙯϒቁ֭၁ϡ۞ᓜԖۢᙊĄд౯઼҂۞࿅ ̚ĂΞͽ൴னᗟϫ̶ј၁ϡۢᙊĂٕߏԆБઐ۞ܝᗟϫĄֱઐ۞ܝ ᗟϫᙱͽ౯Ăҭݒѣ˘ؠ፟ົࢦኑனĂ౯҂Οᗟ̈́࠹ᙯ۞ۢ ᙊົߏ˘࣎࠹၆ѣड़த۞͞ڱĄ ԓ୕ώྎྋਕૉ၆ЧҜጯԙ؏ѣᑒӄĄ၆̰ٺटѣٙႷયٕ ି˵ኛа㒝ගԧࣇĂᔁᔁĊ
በ۰ᖰᙊ
iii
ϫ ᐂ ௐ˘ቔā̰ࡊጯ
1
ௐ 1 ౢā͕̰ࡊ .................................................................. 3 ௐ 2 ౢāට̰ࡊ ................................................................ 23 ௐ 3 ౢāབࡤࡊ .................................................................... 37 ௐ 4 ౢāາౘᔁࡊ ............................................................. 55 ௐ 5 ౢāৠགྷ̰ࡊ ................................................................ 63 ௐ 6 ౢāҕ୵ཚሳࡊ ............................................................. 93 ௐ 7 ౢāඪࡊ .................................................................. 103 ௐ 8 ౢāຏߖࡊ .................................................................. 113 ௐ 9 ౢā࿅ୂҺࠪࢲᒅࡊ.................................................... 123
ௐ˟ቔāγࡊጯ
135
ௐ 1 ౢā˘ਠγࡊ .............................................................. 137 ௐ 2 ౢā͕γࡊ .............................................................. 173 ௐ 3 ౢāۡབγࡊ .............................................................. 183 ௐ 4 ౢāፋԛγࡊ .............................................................. 189 ௐ 5 ౢāටγࡊ .............................................................. 197 ௐ 6 ౢāৠགྷγࡊ .............................................................. 207 ௐ 7 ౢā̈γࡊ .............................................................. 219
v
vi
2013 ѐᗁर઼҂ྏᗟྎྋĈᓜԖᗁጯ Ъဦ३ۤۍā൴Җ
ௐˬቔāࡊ̈́ࡊ
225
ௐ 1 ౢāயࡊ ................................................................ 227 ௐ 2 ౢā̈ ࡊ................................................................ 263 ௐ 3 ౢāϩቲࡊ ................................................................ 317 ௐ 4 ౢāࡊ .................................................................... 345 ௐ 5 ౢāீࡊ .................................................................... 359 ௐ 6 ౢā҅ᆄಘࡊ............................................................. 369 ௐ 7 ౢā౫ዕࡊ ................................................................ 383 ௐ 8 ౢāჟৠࡊ ................................................................ 393 ௐ 9 ౢāکԌࡊ ................................................................ 417 ௐ 10 ౢāާ෧ࡊ ................................................................ 431 ௐ 11 ౢāछलᗁጯࡊ ......................................................... 435 ௐ 12 ౢāೇઉࡊ ................................................................ 447 ௐ 13 ౢāᗁጯࣖநᄃᗁᒚՙඉ .......................................... 469 ௐ 14 ౢāᇆညᗁጯࡊ ......................................................... 487 ણ҂३ϫ ............................................................................ 503
ௐ˘ቔ
̰ ࡊጯ ௐ 1 ౢā͕̰ࡊ ௐ 2 ౢāට̰ࡊ ௐ 3 ౢāབࡤࡊ ௐ 4 ౢāາౘᔁࡊ ௐ 5 ౢāৠགྷ̰ࡊ ௐ 6 ౢāҕ୵ཚሳࡊ ௐ 7 ౢāඪࡊ ௐ 8 ౢāຏߖࡊ ௐ 9 ౢā࿅ୂҺࠪࢲᒅࡊ
ௐ1ౢ
͕̰ࡊ Ğ ğ 1. ၆ާّ͕҉ୟ۞ঽˠซҖҕং໘ྋڼᒚ (thrombolytic therapy) ॡĂ˭Еୃң۰̙ϒቁĉ (A) ڼᒚ۞เܛॡมߏдާّ͕҉ୟ൴ү ޢ6 ̈ॡ̰ග̟ (B) ڼᒚ૱֍۞ઘүϡߏҕ (C) ୟ࠹ᙯ݄ېજਔ (infarct related artery) ̝ҕ߹གྷҕং໘ ྋڼᒚޢĂࡶߏ TIMI grade 1 ۰Ă ྵޢTIMI grade 3 ۰ࠎָ (D) Ъ׀ᚑࢦ۞ҕᑅĞќᒺᑅ̂ ٺ180 mmHgğ۰Ăߏ߉Җ ҕং໘ྋڼᒚ۞༰ԟা Ans Ĉ (C)
Ī102-1Ğˬğ3ī
Hint Ĉ (A) Stroke, tPA < 3H; STEMI, tPA < 6H; STEMI, PCA < 12H. (C) ڦຍ TIMI (Thrombolysis in Myocardial Infarction) grade flow ᄃ TIMI score ۞̙ТĂ TIMI grade ܑϯซҖ angiography ॡ၆݄ېજਔҕ߹۞ෞҤĈ ʔTIMI 0 flow (no perfusion) refers to the absence of any antegrade flow beyond a coronary occlusion. ʔTIMI 1 flow (penetration without perfusion) is faint antegrade coronary flow beyond the occlusion, with incomplete filling of the distal coronary bed. ʔTIMI 2 flow (partial reperfusion) is delayed or sluggish antegrade flow with complete filling of the distal territory. ʔTIMI 3 is normal flow which fills the distal coronary bed completely. 3
ௐ2ౢ
ට̰ࡊ Ğ ğ 1. ˘Ҝ 40 ໐շّĂ٩ඵܜ྿˟˩ѐĂܕវᑭ൴ன۱ొΠ˯ ཧѣ 2 ̶̳۞ඕ༼Ăགྷϒ̄ᛷᇆ̈́ཝొᄃొཝᕝᆸᑭߤ ൴னĂΪѣТ۱͐ܝඕܬϚĂགྷ̷ͯᙋ၁ࠎ̈ܧࡪ۱ ᒛĂঽˠᑕତצңڼᒚࠎዋ༊ĉ (A) ͘ఙ̷ੵĂఙ៍ޢ၅ӈΞ (B) ͘ఙ̷ੵ̈́ఙޢᅃӄّ̼ጯڼᒚ (C) ٸडڼᒚ (D) ֹϡ Gefitinib Ans Ĉ (B)
Ī102-1Ğˬğ42ī
Hint Ĉ NSCLC staging Ĉ T1a Ĉܜश̈ٺඈ ٺ2 cmĞ۱ᒛ̶ഇΒӣ˯ࢨĂ̙Βӣ˭ ࢨğ N1 ĈТ۱ٕܝ۱̰͐ඕ M0 Ĉᅈბᖼொ T1aN1M0 Ĉ Stage IIa Ref Ĉ NCCN 7th guideline Initial treatment by stage Ĉ
Stage IA, IB (< 4 cm)Ĉ surgery Stage IB (> 4 cm)Ĉ surgery Ůఙ̼ޢᒚ Stage II, III (N0 or N1)Ĉ surgery Ůఙ̼ޢᒚ N2, N3 Ĉ concurrent chemoradiation therapy
23
ௐ3ౢ
བࡤࡊ Ğ ğ 1. ˘Ҝ 60 ໐շّঽˠЯཛొཚණҝੰĂࢰگᑭߤ൴னཛ֭ͪ ઇ෧ᕝّ͔߹Ăཛ̶ͪژඕڍϨҕᇴࠎ 300/mm3 Ă̚кԛ ८ࡪ (polymorphonuclear) Κ 35% ĂకϨኳᇴࣃࠎ 2.0 g/dL Ă ϨకϨࣃࠎ 1.2 g/dL ćҕϨకϨࣃࠎ 2.6 g/dL Ă˭Ең۰ࠎ Ξਕ۞෧ᕝĉ (A) ͕ა (Congestive heart failure) (B) ඕ८ّཛቯ( ۆTuberculous peritonitis) (C) ཛቯᒛা (Neoplasm) (D) ෂّཛቯ( ۆPyogenic peritonitis) Ī102-1Ğˬğ1ī Ans Ĉ (A) Hint Ĉ (1) ཛͪᝥҾ෧ᕝੵ˞ཛͪγ៍̝γ۞ௐ˘Վࢍߏܮზ SAAG (serum-ascites albumin gradient)Ăͽѩᗟࠎ 2.6 ů 1.2 = 1.4 g/dL Ăͽ 1.1 g/dL ࠎᝥҾߏӎϤܝਔᑅౄј۞̷౷ᕇĈ
ʔSAAG > Ŷ 1.1 g/dL ĈΞਕѣܝਔᑅ۞хдĂᝥҾ෧ ᕝΒ߁Ĉ cirrhosis, cardiac ascites, sinusoidal obstruction syndrome (venoocclusive disease), massive liver metastasis, ٕ hepatic vein thrombosis (Budd-Chiari syndrome)Ą ʔSAAG < 1.1 g/dL Ĉ҂ᇋܝܧਔᑅౄј۞ཛͪĂᝥҾ෧ ᕝΒ߁Ĉ tuberculous peritonitis, peritoneal carcinomatosis, ٕ pancreatic ascites Ą (2) ҋ൴ّෂّཛቯ۞ۆ෧ᕝᇾĈ Ascites PMN Ÿ 250 cells/mm3, bacteril growth in ascites culture, no evidence of intra-abdominal surgical treatable source of infection Ą 37
ௐ4ౢ
າౘᔁࡊ Ğ ğ 1. ˘Ҝ 45 ໐ّ̃ঽˠĂдઉᑭߤཛొཝᕝᆸ൴ன˘࣎ۡश 3 ̶̳۞Πඪ˯ཛྷཚሳĂтңநޫ༊ĉ (A) ᖼ̬ঽˠତצฟ˥ (B) ീྏඪ˯ཛྷϩኳăលኳΑਕ (C) ү੫ࡍוࡪጯᑭߤ (D) ٺ6 ࣎͡ޢГઇ 1 Ѩཝᕝᆸ Ans Ĉ (B)
Ī102-1Ğˬğ58ī
Hint Ĉ ٺᇆညጯᑭߤຍγ൴னٺඪ˯ཛྷѣ 1 ̶̳ͽ˯۞ཚሳĂჍࠎ adrenal incidentama Ą ତ˭ֽ۞෧၅ࠎҿᕝ࣎ཚሳߏӎࠎೋّĂ̈́ߏӎࠎ functioning Ą ʔߏӎࠎೋّ۞পᇈ఼૱Ϥ CT ᇆညጯ˯۞পᇈֽઇҿᕝĂ тĈ irregular shape, inhomogeneous density, high unenhanced CT attenuation values (> 20 HU), delayed contrast medium washout (eg, < 50 percent at 10 minutes), diameter > 4 cm, and tumor calcification Ą੫ࡍו၆ᝥҾ։ّೋّ֭ᑒӄĄ ʔߏӎࠎ functioning tumor ĂീྏϩኳលኳΑਕߏӎѣ ள૱Ą
55
ௐ5ౢ
ৠགྷ̰ࡊ Ğ ğ 1. 60 ໐շّٺཛજਔࣤᗓ ޢ3 ͟Ă൴னᗕ˭۳˧ᄃ౫͢ă ε༰Ăৠགྷጯᑭߤពϯ˭۳۞ຏᛇΑਕள૱Ăҭ˭Еңຏᛇ Αਕ̪Ξਕߏϒ૱ĉ (A) ॎજຏ (vibration) (B) ᛈຏ (touch) (C) ޘຏ (temperature) (D) ੫וຏ (pin-prick) Ans Ĉ (A)
Ī102-1Ğαğ46ī
Hint Ĉ 1. ཛજਔࣤᗓޢĂனᗕ۞˭۳ৠགྷጯাېĂΞᘃႷߏ spinal artery infarction ౄјĂ̚૱֍۞ߏ anterior spinal artery ۞યᗟĂ anterior spinal artery ֻᑕ˞ spinal cord ݈ 2/3 ొ̶ć࠹၆۞Ă posterior spinal artery ડા۞ୟޝց֍Ą 2. ᗟϫٙা̚ېĂᗕ˭۳˧ࡶ lesion д spinal cord ۞ྖົ ߏ corticospinal tractĞٕჍ pyramidal tractğĂ̶ј anterior lateral ྮशĂ࠰ᛳ ٺanterior spinal artery ֻගҕ୵۞ቑ ಛĂЯѩѣΞਕߏ anterior spinal artery infarction ćຏᛇ ྮश̚ĂҜ ߏ۞͞ޢٺfasciculus gracilis fasciculus cuneatus გᔑ۞ߏώវຏᛇăஎᛈᛇăዩજᛇඈඈĄ (B)ă(C)ă(D)ࢋߏϤ spinothalamic tract ೠგĂҜ݈͞ٺ ͞Ą
63
ௐ6ౢ
ҕ୵ཚሳࡊ Ğ ğ 1. 74 ໐۞ڒАϠᎮଈ multiple myeloma ˟ѐĂགྷ̼ጯڼᒚ̝ޢซ ˢቤྋഇĄд̫ѐ͇൴னᗕ͘͘ົតϨޢតĞܢဦν ᙝğĂ̙˳̝ޢΠ҅ϩቲតโ҃ᗼѪĞܢဦΠᙝğĄ˭Ең ᑭߤ၆Ҝଈ۰۞෧ᕝѣᑒӄĉ
(A) Cryoglobulins
(B) Prothrombin time
(C) Anti-nuclear antibodies
(D) Protein electrophoresis
Ans Ĉ (A)
Ī102-1Ğˬğ37ī
Hint Ĉ Ꮪͩன෪ᄃ multiple myeloma ঽΫĂ೩ϯ˞ҽకϨҕা ௐ˘( ݭCryoglobulinemia, type I)ĂϤಏঀҺࠪకϨ (monoclonal Ig) ౄјĄௐ˘۞ݭা̂ېкᄃҕ୵ᕆ႖ّ (hyperviscosity) ᄃ thrombosis ѣᙯĄϩቲ࠹ᙯাېΒ߁ĈᏚͩன෪ă digital ischemia ăშې (livedo reticularis)ă pupura Ąڶې ᚑࢦॡĂົซणј gangrene ĄᔘѣৠགྷাېĂтෛ˧ሀ 93
ௐ7ౢ
ඪࡊ Ğ ğ 1. ˘Ҝ 65 ໐ঽˠ࣎͡˘ܕিࢽă֕ྮײӛާܳĄ˩ѐ݈෧ᕝ ඪঽা࣏ཏĂග̟ᙷዔڼᒚड़̙ڍၓĄ۞ҕ҉ᅕ⁇̣ ѐ݈ࠎ 2.8 mg/dL Ăѐ݈˯̿Ҍ 5.2 mg/dL ćѩѨᑭߤࠎ 9.5 mg/dL Ă BUN 120 mg/dL Ăҕࡓ৵ 8.5 g/dL ĂྋኳĈ Na 139 mmol/L Ă K 5.8 mmol/L Ă Cl 103 mmol/L Ă Ca 7.8 mg/dL Ă P 7.0 mg/dL Ąѣᙯѩঽˠ۞ཉ˭Ең۰ྵ̙ዋ༊ĉ (A) ග̟ erythropoietin ڦड (B) ঽˠઘϥېཛྷ৵፧఼ޘ૱ົ˯̿ĂΞАϡ CaCO 3 ଠטᒤ ᗓ̄ (C) Ξ҂ᇋග̟ҕგૺ˧৵ௐ˘צݭវԺט (angiotensin type I receptor blocker) ഴቤඪΑਕੜ (D) Ξ҂ᇋฟؕڼژᒚ Ans Ĉ (C)
Ī102-1Ğˬğ26ī
Hint Ĉ (A) إϏฟّؕၙ۞ژඪঽঽˠĂޙᛉд Hb < 10g/dL ॡ ฟֹؕϡ EPO Ąϫᇾд 10.0 ~ 11.5 ̝มĄтڍ࿅ 13 ॡ ΞਕᆧΐᓜԖࢲᐍĄ (B) ඪΑਕაĂΞਕౄјវ̰ᔁᆿુۏ᎕ĂΒ߁ĈԌ৵ă ઘϥې৵ă β 2-microglobulin Ąඪაጱ۞ᒤҲถ˵ ົֹઘϥېཛྷ፟ਕ̤ซĄڼᒚΒ߁ྃ·ჯϠ৵ D ăࢨᒤ̈́ ֹϡᒤᗓ̄ちЪ (Calcium carbonate ٕ calcium acetate)Ą (C) ֹϡ ACEI ޢΞਕົౄјҕ࿔Ąᔵ ACEI ޙᛉϡٺඪ ঽা࣏ཏ۞ঽˠĂΞഴቤඪঽតిޘĂҭঽˠϫ݈̏ѣ ҕ࿔Ă̙ޙᛉֹϡĄ
103
ௐ8ౢ
ຏߖࡊ Ğ ğ 1. ଂዎזຑൄঽ߲ຏߖĂͽזᑭീྏΞઍീזຏߖ۞˘࣎ ͡νΠ۞ॡม̰ĂᑭീඕڍΞਕனંౚّĄ߱ഇมჍࠎ ̦ᆃഇĉ (A) ۩ഇ (window period) (B) ሕЄഇ (incubation period) (C) ޭೇഇ (recovery period) (D) ൴ঽഇ (developing period) Ans Ĉ (A)
Ī102-1Ğˬğ61ī
Hint Ĉ ۩ഇ (window period)Ĉຑൄঽ߲ຏߖޢĂᅮࢋགྷ࿅˘߱ॡ มҕ୵̖ົயϠຑൄঽ߲ԩវĂЯѩдຏߖ۞ޢѝഇĂΞਕ ЯԩវإϏயϠĂ҃ᑭរӔౚّͅᑕĂѩӈࠎ۩ഇĄ˘ਠ ҃֏Ă۩ഇࡗߏຑൄঽ߲ຏߖ ޢ6-12 ฉ̰Ă࿅Ν˵ѣߐ ۞ಡӘ൴ன۩ഇܜ྿ 12 ࣎͡Ąᐌᑭរ͞ё۞ซՎĂ۩ ഇ̏Ξͽᒺൺ ז1-2 ߐഇĄдѩഇมĂଈ۰វ̰۞ຑൄঽ߲ঽ ߲ณĂ็ߖ˧ૻĄ
ሕЄഇ (incubation period)Ĉຏߖຑൄঽ߲זޢனᓜԖা ۞ېഇมâਠߏ 5-10 ѐĞϫ݈ჍࠎᔳԛഇٕѨᓜԖഇğĄҭ ߏĂт݈Ăຑൄঽ߲ຏߖ۞ޢঽԣၙ̙˘Ą۩ഇٕሕ ЄഇॡĂధкଈ۰՟ѣাېĂଈ۰ΞਕᚶᜈଂְПᐍّҖ ࠎĂЯѩјࠎຑൄঽ߲֨۞ڼ႒߽Ą ણ҂ҋ CDC Ą
113
ௐ9ౢ
࿅ୂҺࠪ ࢲᒅࡊ Ğ ğ 1. ͽҺࠪᏈЍڱઇԩ८ԩវ (ANA) ॡĂඕ˞ੵڍ፧ޘҲ γĂΩਕ࠻८ߖҒ̝ᙷ( ݭpattern)Ă˭Е֤˘ᙷݭᄃБ֗ ّർ̼া (systemic sclerosis) ࠹ᙯّĉ (A) Centromere pattern
(B) Peripheral pattern
(C) Cytoplasmic pattern
(D) Homogenous pattern
Ans Ĉ (A) Hint Ĉ
Ī102-1Ğˬğ33ī
ANA patern
Clinical correlate
Peripheral (Rim) pattern
50% of SLE (specific)
Diffuse (Homogenous) pattern
Lupus
Speckled pattern
Unspecific (Sjogren’s syn., SLE, MCTD)
Cytoplasmic pattern
Autoimmune hepatitis, primary biliary atresia
Nucleolar pattern
40% of diffuse systemic sclerosis
Centromere pattern
Limited scleroderma (75% CREST syn.)
Ğ ğ 2. ˭Ең۰၆ Cyclooxygenase (COX)-2 ̝ᏴፄّԺّטĉ (A) ܠ̽ី (Aspirin)
(B) Celecoxib
(C) Ibuprofen
(D) Indomethacin
123
ௐ˟ቔ
γ ࡊጯ ௐ 1 ౢā˘ਠγࡊ ௐ 2 ౢā͕γࡊ ௐ 3 ౢāۡབγࡊ ௐ 4 ౢāፋԛγࡊ ௐ 5 ౢāටγࡊ ௐ 6 ౢāৠགྷγࡊ ௐ 7 ౢā̈γࡊ
ௐˬቔ
ࡊ̈́ࡊ ௐ 1 ౢāயࡊ ௐ 2 ౢā̈ࡊ ௐ 3 ౢāϩቲࡊ ௐ 4 ౢāࡊ ௐ 5 ౢāீࡊ ௐ 6 ౢā҅ᆄಘࡊ ௐ 7 ౢā౫ዕࡊ ௐ 8 ౢāჟৠࡊ ௐ 9 ౢāکԌࡊ ௐ 10 ౢāާ෧ࡊ ௐ 11 ౢāछलᗁጯࡊ ௐ 12 ౢāೇઉࡊ ௐ 13 ౢāᗁጯࣖநᄃᗁᒚՙඉ ௐ 14 ౢāᇆညᗁጯࡊ