[{"data":1,"prerenderedAt":65},["ShallowReactive",2],{"q-nurse-115-1-medical-surgical-012":3},{"subject":4,"subjectSlug":5,"subjectFullName":4,"question":6,"related":34,"lastmod":64},"內外科護理學","medical-surgical",{"id":7,"webId":8,"year":9,"session":10,"subject":4,"number":11,"stem":12,"options":13,"answer":18,"answerNote":19,"images":20,"explanation":21,"explanationDeep":22,"topics":23,"freq":10},"nurse-115-1-內外科護理學-012","nurse-115-1-medical-surgical-012",115,1,12,"有關不同關節炎之比較，下列何者正確？",{"A":14,"B":15,"C":16,"D":17},"類風濕性關節炎是一種與老化有關的疾病","退化性關節炎是一種嘌呤代謝異常的疾病","痛風性關節炎好發於男性四肢遠端關節","退化性關節炎好發於55歲以上女性周邊小關節","C",null,[],"本題考點是常見關節炎的鑑別診斷。痛風性關節炎源於嘌呤代謝異常與高尿酸血症,尿酸鈉結晶容易沉積在體溫較低、血流較慢的四肢遠端關節,以第一蹠趾關節最典型,加上雄性素與尿酸代謝的差異,好發於中年男性,故 C 正確。A 錯在類風濕性關節炎屬自體免疫性滑膜炎,對稱侵犯手部小關節、好發中年女性,與老化並無直接關係。B 把嘌呤代謝異常安到退化性關節炎頭上,退化性關節炎的機轉是關節軟骨磨損與軟骨下骨硬化的機械性退化。D 錯在退化性關節炎主要侵犯膝、髖、脊椎等承重關節,手部則以遠端指間關節的 Heberden 結節表現,並非以周邊小關節為主。","三種關節炎的病理對照要精確到結晶名稱。痛風沉積的是尿酸鈉(monosodium urate)結晶,偏光顯微鏡下呈針狀、負性雙折射;假性痛風(pseudogout)沉積的則是焦磷酸鈣二水合物(CPPD, calcium pyrophosphate dihydrate)結晶,呈菱形或短棒狀、正性雙折射,好發於膝與腕,X 光可見軟骨鈣化。名稱最容易混:CPPD 是焦磷酸鈣,與磷酸鈣(氫氧磷灰石)沉積症是另一種結晶性關節炎,兩者不可混用。類風濕性關節炎屬自體免疫疾病,滑膜增生形成血管翳侵蝕軟骨與骨,晨僵常超過一小時,RF 與 anti-CCP 抗體陽性,對稱侵犯掌指與近端指間關節;退化性關節炎則是軟骨磨損、軟骨下骨硬化與骨刺形成,晨僵少於 30 分鐘、活動愈多愈痛,手部表現為遠端指間關節的 Heberden 結節與近端指間關節的 Bouchard 結節。口訣:「針狀負性是痛風,菱形正性是假性痛風;晨僵長屬免疫、晨僵短屬磨損」。延伸可連結高尿酸血症的飲食與藥物誘因,以及 OA 的關節間隙變窄影像特徵。",[24,26,28,30,32],{"term":25,"count":10},"嘌呤代謝與高尿酸血症",{"term":27,"count":10},"尿酸鈉結晶負性雙折射",{"term":29,"count":10},"焦磷酸鈣二水合物結晶",{"term":31,"count":10},"類風濕性關節炎自體免疫機轉",{"term":33,"count":10},"退化性關節炎軟骨磨損",[35,39,44,49,54,59],{"webId":36,"stem":37,"number":38,"year":9,"session":10},"nurse-115-1-medical-surgical-013","有關急性中耳炎的醫療處置，下列何者錯誤？",13,{"webId":40,"stem":41,"number":42,"year":43,"session":10},"nurse-106-1-medical-surgical-009","王先生因直腸癌入院手術，醫師採用腹部會陰切除術及結腸造口術，術後 1 個月，教導王先生自我執行結腸灌洗之護理指導，下列何者錯誤？",9,106,{"webId":45,"stem":46,"number":47,"year":43,"session":48},"nurse-106-2-medical-surgical-023","有關鼻咽癌症狀之敘述，下列何者錯誤？",23,2,{"webId":50,"stem":51,"number":52,"year":53,"session":48},"nurse-107-2-medical-surgical-061","有關鹿角結石之敘述，下列何者錯誤？",61,107,{"webId":55,"stem":56,"number":57,"year":58,"session":10},"nurse-109-1-medical-surgical-025","一位 26 歲新婚女性，有計畫懷孕，近日因心臟不適，經醫師診斷二尖瓣狹窄，並建議更換心臟瓣膜，有關瓣膜選擇與抗凝劑使用之敘述，下列何者最適當？",25,109,{"webId":60,"stem":61,"number":62,"year":63,"session":10},"nurse-110-1-medical-surgical-059","病人的動脈血氧分析結果 PaO 2 值為 50 mmHg，此病人 PaO 2 的判讀及處置，下列何者正確？",59,110,"2026-08-06",1787299088654]