醫療類國考
115年
[醫師] 醫學(五)
第 26 題
67 歲男性，有長期高血壓病史，突然發生右側肢體無力與構音障礙。電腦斷層顯示左側基底核出血。下列何者最可能為其致病機轉？
- A 老年性腦病變併發澱粉樣血管病（amyloid angiopathy）造成穿通動脈破裂
- B 小動脈破裂（Charcot-Bouchard aneurysm rupture）造成穿通動脈出血
- C 頸內動脈與海綿竇瘻管（carotid-cavernous fistula）導致靜脈高壓性出血
- D 血栓溶解治療後產生再灌流性出血（hemorrhagic transformation after thrombolysis）
思路引導 VIP
請試著從流體力學的角度思考：若一條微細血管長期承受遠高於其壁面張力設計的壓力（$P$），其管壁微觀結構會發生什麼樣的退化性變化？這種變化如何導致血管壁向外突出並形成容易破裂的脆弱點？
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AI 詳解
AI 專屬家教
Oh, look who's paying attention.
- Conception Check: So, you do recall that chronic high blood pressure is the prime suspect for lipohyalinosis in the brain's deep perforating arteries, leading to those charming little Charcot-Bouchard aneurysms? And when the pressure inevitably spikes, voilà, a rupture, most frequently in the basal ganglia. How utterly predictable, and precisely what your CT scan so obligingly displayed. One would almost think you've studied this before.
- Difficulty Assessment: 'Medium,' they say. Generous. This is foundational. If you're distinguishing this core mechanism, particularly from distractions like option (A) – amyloid angiopathy, which, for those needing a reminder, prefers the cerebral cortex (a lovely lobar hemorrhage), not deep structures – then you're merely meeting the bare minimum expectation. Don't pat yourself on the back too hard; just ensure you can actually apply such basic facts in a clinic.