[{"data":1,"prerenderedAt":73},["ShallowReactive",2],{"q-nurse-108-1-psychiatric-community-059":3},{"subject":4,"prev":5,"next":8,"subjectSlug":11,"subjectFullName":4,"question":12,"related":44,"lastmod":72},"精神科與社區衛生護理學",{"webId":6,"number":7},"nurse-108-1-psychiatric-community-058",58,{"webId":9,"number":10},"nurse-108-1-psychiatric-community-060",60,"psychiatric-community",{"id":13,"webId":14,"year":15,"session":16,"subject":4,"number":17,"stem":18,"scenario":19,"carryOver":19,"options":20,"answer":25,"answerNote":19,"images":26,"explanation":27,"explanationDeep":28,"topics":29,"freq":16,"concepts":40},"nurse-108-1-精神科與社區衛生護理學-059","nurse-108-1-psychiatric-community-059",108,1,59,"有關梅毒的敘述，下列何者正確？①晚期梅毒傳染性較強　②性行為是主要傳染途徑　③孕期 35 週需接受梅毒篩檢　④孕期感染梅毒，胎兒可經垂直傳染罹患先天性梅毒",null,{"A":21,"B":22,"C":23,"D":24},"①②","①③","②④","③④","C",[],"本題考點是梅毒的傳染途徑、垂直傳染與各期傳染力。②正確:病原體 Treponema pallidum 主要經性行為時黏膜或皮膚的微小破損直接接觸病灶而傳染。④正確:孕婦感染後螺旋體可經胎盤垂直傳染,造成先天性梅毒(鞍鼻、哈欽森齒、間質性角膜炎等),故選 C。①錯:傳染力為前重後輕,第一期硬性下疳與第二期皮疹、扁平濕疣含大量螺旋體,傳染力最強;第三期以組織破壞病變為主,病灶內螺旋體極少。③錯:我國孕婦梅毒血清篩檢排在第一次產檢(約妊娠 12 週前);35 至 37 週例行採檢的是 B 群鏈球菌(GBS)。","【分期與傳染力】第一期(感染後約 3 週):無痛性硬性下疳,傳染力最高。第二期(約 6 週至 6 個月):全身性斑丘疹、手掌腳掌皮疹、扁平濕疣、全身淋巴結腫,傳染力仍高。潛伏期:無症狀但血清陽性,早期潛伏(1 年內)仍具傳染力,晚期潛伏傳染力低。第三期(數年至數十年後):梅毒腫、心血管梅毒(升主動脈瘤)、神經性梅毒(全身麻痺性痴呆、脊髓癆、Argyll Robertson 瞳孔),此期已屬組織的免疫反應破壞,傳染力低。口訣「早期會傳、晚期會殘」。\n\n【血清學檢查的分工】非特異性(反應素)試驗 VDRL、RPR:價廉、可定量,titre 隨治療下降(療效判定以 titre 下降四倍為有效),故用於篩檢與追蹤療效;偽陽性可見於自體免疫疾病、懷孕、急性感染。特異性試驗 TPHA、TPPA、FTA-ABS:確認診斷用,治療後仍終身陽性,因此不能拿來判斷是否治癒或再感染。\n\n【治療與 Jarisch-Herxheimer 反應】首選 Penicillin G(早期梅毒單劑肌肉注射 benzathine penicillin G,神經性梅毒改用靜脈注射水溶性 penicillin G);孕婦一律使用 penicillin,對其過敏者須先減敏後仍給 penicillin,因四環黴素類對胎兒有害、紅黴素無法有效通過胎盤。首次投藥後 24 小時內可能出現 Jarisch-Herxheimer 反應——發燒、寒顫、頭痛、肌痛、皮疹暫時加重。其機轉是大量螺旋體被殺死後菌體崩解,釋出脂蛋白與類脂質等菌體成分,誘發 TNF-α、IL-6、IL-8 等發炎細胞激素急遽釋放所致;須留意 Treponema pallidum 屬螺旋體,細胞壁不含革蘭氏陰性菌那種脂多醣(LPS)內毒素,因此這個反應並非內毒素血症,寫成「釋出內毒素」是常見的錯誤說法。此反應屬自限性,不是青黴素過敏,兩者的鑑別是考試重點。\n\n【先天性梅毒】早期(2 歲前):肝脾腫大、鼻炎(snuffles)、皮疹、假性麻痺、長骨骨軟骨炎。晚期(2 歲後):Hutchinson 三聯症——哈欽森齒、間質性角膜炎、感覺神經性聽力喪失,另有鞍鼻、軍刀狀脛骨。",[30,32,34,36,38],{"term":31,"count":16},"梅毒分期與傳染力",{"term":33,"count":16},"垂直傳染與先天性梅毒",{"term":35,"count":16},"VDRL\u002FRPR 與 TPHA",{"term":37,"count":16},"Penicillin G",{"term":39,"count":16},"Jarisch-Herxheimer 反應",[41],{"id":42,"name":43},"infectious-diseases","社區重要傳染病",[45,47,52,57,62,67],{"webId":9,"stem":46,"number":10,"year":15,"session":16},"根據 Donabedian（1982）提出的結構（structure）、過程（process）、結果（outcome）概念進行社區健康方案的評值，下列何者正確？",{"webId":48,"stem":49,"number":50,"year":15,"session":51},"nurse-108-2-psychiatric-community-076","國小入學新生，其健康檢查必要檢查項目為：①尿液檢查 ②立體感篩檢 ③耳鼻喉科檢查 ④蟯蟲檢查 ⑤血液檢查",76,2,{"webId":53,"stem":54,"number":55,"year":56,"session":51},"nurse-109-2-psychiatric-community-010","團體成員在團體中，覺得自己的問題不再是那麼特殊，可以分享各自的感受，而得到相互支持，這項團體的治療性因子，下列何項正確？",10,109,{"webId":58,"stem":59,"number":60,"year":61,"session":51},"nurse-110-2-psychiatric-community-048","社區護理師宜根據流行病學的方法學進行健康議題之評估，下列敘述何者正確？",48,110,{"webId":63,"stem":64,"number":65,"year":66,"session":16},"nurse-112-1-psychiatric-community-012","有關團體治療的敘述，下列何者最適宜？",12,112,{"webId":68,"stem":69,"number":70,"year":66,"session":71},"nurse-112-3-psychiatric-community-046","有關居家護理師之角色與功能之敘述，下列何者錯誤？",46,3,"2026-09-29",1790672291253]