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140. 一位55歲男性二天前突然右腳踝痛及腫脹，病人有20年抽菸習慣，偶爾喝酒，二周前並曾有小便微痛及灼熱感，下列檢驗對病人最有幫助？
(1) 抗核抗體 (antinuclear antibody)；
(2) 人類白血球抗原-B27(HLA-B27)；
(3) 尿酸；
(4) 抗瓜胺酸蛋白抗體 (ACPA)；
(5) 抗嗜中性白血球細胞質抗體 (ANCA)
(A) (1)+(5)
(B) (1)+(4)
(C) (2)+(3)
(D) (2)+(4)
(E) (3)+(5)

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難度： 簡單

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 【站僕】摩檸Morning：請問這題怎麼解？
倒數 1天 ,已有 1 則答案
. 大三上 (2021/09/30):

題幹描述為關節炎的表徵，兩周前有小便微痛及灼熱感，可能有泌尿道感染的情形，因此推斷可能有Gouty arthritis 和reactive arthritis (UTI induced)的可能性，關於reactive arthritis在Harrison 20th Edition, chap125, infectious arthritis, p.943”Postinfectious or reactive arthritis” section有提到:

Reactive polyarthritis develops several weeks after ~1% of cases ofnongonococcal urethritis and 2% of enteric infections, particularlythose due to Yersinia enterocolitica, Shigella flexneri, Campylobacter jejuni,and Salmonella species. Only a minority of these patients have the otherfindings of classic reactive arthritis, including urethritis, conjunctivitis,uveitis, oral ulcers, and rash. 

Reactive arthritis is most common among young men (except afterYersinia infection) and has been linked to the HLA-B27 locus as a potentialgenetic predisposing factor.

故選項(2)(3)為正確

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140. 一位55歲男性二天前突然右腳踝痛及腫脹，病人有20年抽菸習慣，偶爾喝酒..-阿摩線上測驗