皮膚科王修含醫師: 中華皮膚科醫學雜誌繼續教育測驗-第28卷第4期

中華皮膚科醫學雜誌繼續教育通訊試題測驗-第28卷第4期

作答&解說：皮膚科王修含醫師
內容僅供參考

第二十八卷第四期
考試日期範圍考試起始日期:2011/1/28 考試結束日期:2011/4/30
題目1: 下列細胞中，哪一種少見於神經纖維瘤(neurofibroma)中?
(A) 許旺細胞(Schwann cell)
(B) 肥大細胞(Mast cell)
(C) 纖維母細胞(Fibroblast)
(D) 蘭格罕氏細胞(Langerhans cell)

答案：D
解說：Neurofibroma consists of abundant extracellular matrix and many types of cells, including Schwann cells (SCs), mast cells (MCs), fibroblasts and endothelial cells.

Ref: DERMATOLOGICA SINICA 28 (2010) 146–153

題目2: 下列關於神經纖維瘤(neurofibroma)的敘述，哪個選項正確?
1.腫瘤內常可看到肥大細胞(mast cell)
2.神經纖維瘤第一型(Neurofibromatosis type 1)是一種自體顯性(autosomal dominant)遺傳的疾病
3.神經纖維瘤第一型(Neurofibromatosis type 1)主要致病基因NF1 gene為腫瘤抑制基因(tumor suppressor gene)
4.皮膚及神經纖維瘤內的肥大細胞的移動與趨化因子受體(chemokine receptor)有關
(A) 1、3
(B) 2、4
(C) 1 、2 、3
(D) 4
(E) 1 、2 、3、4

答案：E
解說：
1. Neurofibroma consists of abundant extracellular matrix and many types of cells, including Schwann cells (SCs), mast cells (MCs), fibroblasts and endothelial cells.

2. Neurofibromatosis type 1 is considered to have an autosomal dominant pattern of inheritance.
Ref: http://ghr.nlm.nih.gov/condition/neurofibromatosis-type-1

3.The NF1 gene, a tumor suppressor gene, has been identified as the main pathogenic gene for NF1 (in loss of function), and its gene product, the neurofibromin protein, has been characterized as an antagonist of Ras protein, a well-known oncogene product signaling cell proliferation and apoptosis resistance.

4. The interaction of CCR3 and CCL7 may play important roles for MC migration toward SC in the neurofibroma.

Ref: DERMATOLOGICA SINICA 28 (2010) 146–153

題目3: 下列哪個病毒與默克細胞癌(Merkel cell carcinoma)的生成有關?
(A) 多瘤病毒 (polyomavirus)
(B) 人類乳突病毒 (Human papilloma virus)
(C) 正黏液病毒（Orthomyxoviridae）
(D) EB病毒 ((Epstein-Barr virus)

答案：A
解說：In 2008, the clonal integration of a new human polyomavirus, named Merkel cell polyomavirus (MCPyV), was found to be closely associated with the development of MCC.

Ref: DERMATOLOGICA SINICA 28 (2010) 159–162

題目4: 下列有關默克細胞癌(Merkel cell carcinoma)的敘述何者正確?
1.主要侵犯老人及免疫力低下的患者
2.特殊染色CK-20陽性，CK-7陰性
3.此腫瘤生成速度快，且好發陽光曝曬部位
4.目前發現一特殊的多瘤病毒感染與此腫瘤生成有關
(A) 1、3
(B) 2、4
(C) 1 、2 、3
(D) 4
(E) 1 、2 、3、4

答案：E
解說：
1. Merkel cell carcinoma (MCC) is a rare malignancy with aggressive behavior mostly seen in the elderly and immunosuppressed patients.

2. It consists of malignant small blue round cells typically expressing neuroendocrine markers and has a characteristically paranuclear dot-like expression pattern of cytokeratin (CK)-20.

3. MCC is a rare and aggressive neuroendocrine tumor. Its mortality rate is high and its overall survival rate ranges between 25% and 75%. It usually appears as a solitary, violaceous, dome-shaped nodule or indurated plaque in a sun-exposed area.

4. In 2008, the clonal integration of a new human polyomavirus, named Merkel cell polyomavirus (MCPyV), was found to be closely associated with the development of MCC.

Ref: DERMATOLOGICA SINICA 28 (2010) 159–162

題目5: 洗髮精所造成的過敏性接觸皮膚炎，下列何者不正確?
(A) 洗髮精造成的過敏性接觸皮膚炎可以在頭部、臉部、手部等部位造成皮膚炎
(B) 在乾癬的病人，洗髮精過敏有可能造成膿疱型乾癬的發作
(C) 洗髮精中的抗屑成份Zinc pyrithione是很常造成過敏性接觸皮膚炎的過敏原之一
(D) 確定過敏原的最佳方式為貼布試驗

答案：C
解說：
Zinc pyrithione is a common active ingredient with a low potential of irritation and sensitization in antidandruff shampoo; it is often recommended for individuals with seborrheic dermatitis or psoriasis.

Ref: DERMATOLOGICA SINICA 28 (2010) 163–166

題目6: 有關洗髮精過敏性接觸皮膚炎的貼布試驗，下列何者不正確?
(A) 通常以洗髮精原液直接貼在病人皮膚上測驗
(B) 最好選在病人病情緩解、且不需使用藥物治療時進行測試
(C) 可以使用其它人當作貼布對照組，來幫助判定
(D) 貼布試驗的偽陽性很高

答案：A
解說：
Of all products applied on the scalp, irritant and questionable patch test reactions occur most frequently in hair cleaning products because of their unusually long stay and occlusive conditions in patch tests.

Selection of a proper diluted concentration and using a control group can improve the accuracy of patch tests.

Interpreting the results of patch tests also requires much care because of a high false-positive rate.

Ref: DERMATOLOGICA SINICA 28 (2010) 163–166

題目7: 以下關於種痘樣水疱病(hydroa vacciniforme, HV)的敘述下列何者錯誤?
(A) 一種好發在孩童時期的光敏感疾病
(B) 特徵是在日光曝曬區域反覆出現牛痘樣水疱、壞死性潰瘍與疤痕
(C) 一般為良性病程，隨年紀增長會逐漸改善
(D) 目前並未發現與Epstein-Barr virus (EBV)的關聯性

答案：D
解說：Hydroa vacciniforme (HV) is a photosensitivity disorder in childhood characterized by
recurrent vacciniform vesicles, necrotic ulcers, and scars on sun-exposed areas.

The disease is usually sporadic with onset in childhood and resolution by early adult life.

HV, atypical HV and HV-like lymphoma belong to the spectrum of Epstein-Barr virus (EBV)-associated lymphoproliferative disorders.

Ref: DERMATOLOGICA SINICA 28 (2010) 167–172

題目8: 以下關於種痘樣水疱病樣淋巴瘤(hydroa vacciniforme-like lymphoma)的敘述下列何者錯誤?
(A) 是一種與Epstein-Barr virus (EBV)相關的淋巴增殖性病變
(B) 病灶分布的位置廣泛，包含非日光曝曬區域
(C) 病人常合併發燒、肝脾腫大等系統性症狀
(D) 雖然已有不少病例陸續被報告，但目前尚未納入WHO對淋巴瘤最新分類之中

答案：D
解說：HV-like lymphoma is a rare, newly-classified cutaneous T-cell lymphoma in association with chronic latent Epstein-Barr virus (EBV) infection.

The previously documented cases of lymphoma with HV-like lesions had been grouped under EBV-positive T-cell LPDs of childhood in the WHO Classification of Tumors of Hematopoietic and
Lymphoid Tissues, 2007 and specified as HV-like lymphoma (ICD-O 9725/3).

Ref: DERMATOLOGICA SINICA 28 (2010) 167–172

題目9: 在apocrine hidrocystoma及eccrine hidrocystoma的鑑別診斷包括下列各項，何者除外:
(A) Apocrine hidrocystomas have cyst wall lined of myoepithelial cells
(B) Eccrine hidrocystomas may have a seasonal variation
(C) Apocrine hidrocystomas are located in the head and neck
(D) Eccrine hidrocystomas are covered by two layers of cuboidal or flattened cells

答案：C
解說：Although the apocrine glands in humans are mostly distributed in the region of the eyelids, external auditory canal, axilla and on the nipple, apocrine hidrocystoma (AH) has also been reported at other sites, such as the shoulder, fingers, and perianal and periumbilical regions.

AH differs from eccrine hidrocystoma by the presence of decapitation secretion and myoepithelial cells.

AH is currently considered an adenomatous cystic proliferation of the apocrine glands, whereas eccrine hidrocystoma is considered a true retention cyst that presents as unilobular cysts
that are covered by two layers of cuboidal or flattened cells.

Eccrine hidrocystoma has a seasonal variation that is absent in AH.

Ref: DERMATOLOGICA SINICA 28 (2010) 177–178

題目10: 下列有關於非結核性分枝桿菌Mycobacterium abscessus之敘述，何者為非？
(A) 治療使用傳統的抗結核藥通常有不錯的效果
(B) 通常好發於抵抗力不佳的宿主並引起感染症狀，除了成年病患的肺部感染外，還有孩童的頸部淋巴腺感染、皮膚軟組織骨骼感染，及免疫機能不全病患的全身性感染
(C) 治療必須依據藥物感受性試驗結果給藥，合併或不合併外科手術治療
(D) 若免疫機能不全病患皮膚軟組織出現化膿性病灶，必須將此類非結核性分枝桿菌的感染列入鑑別診斷

答案：A
解說：M. abscessus fails to respond to standard antituberculous agents.
This emphasizes the need for tissue diagnosis and obtaining specimens for culture and drug susceptibility testing, with use of empirical therapy suggested until susceptibilities are known. M. abscessus is susceptible to amikacin, cefoxitin, imipenem, and clarithromycin. In disseminated disease, combination therapy for at least 6 months is recommended
to prevent resistance.

Ref: DERMATOLOGICA SINICA 28 (2010) 179–180

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