考點
考點總覽
把 101–115 年 750 題拆成 2167 個考點,其中 614 個考過兩題以上。考點依 Fitzpatrick 9e 的 Part 分頁,每頁依考過的題數排序;點開考點可看到每一次的考法、牽涉的章節,以及常被拿來當陷阱的錯誤觀念。
題目取自臺灣皮膚科醫學會專科醫師甄審筆試試題,答案為學會公告的標準答案;重點與詳解依據 Fitzpatrick's Dermatology, 9th Edition 與 McKee's Pathology of the Skin, 5th Edition 整理
統計方式:題數=考過這個考點的不重複題數;陷阱次數=以該錯誤觀念出題的誘答選項數,不計否定題或「以上皆是」題中本身正確的選項、標記排除統計的選項,以及課本證據不足的選項。
沒有符合的考點,請換個關鍵字或章節。
依 Fitzpatrick Part 瀏覽
- Part 1 Foundations of Clinical Dermatology
- Part 2 Structure and Function of Skin
- Part 3 Dermatitis
- Part 4 Psoriasiform Disorders
- Part 5 Lichenoid and Granulomatous Disorders
- Part 6 Neutrophilic, Eosinophilic, and Mast Cell Disorders
- Part 7 Reactive Erythemas
- Part 8 Disorders of Cornification
- Part 9 Vesiculobullous Disorders
- Part 10 Autoimmune Connective Tissue and Rheumatologic Disorders
- Part 11 Dermal Connective Tissue Disorders
- Part 12 Subcutaneous Tissue Disorders
- Part 13 Melanocytic Disorders
- Part 14 Acneiform Disorders
- Part 15 Disorders of Eccrine and Apocrine Sweat Glands
- Part 16 Disorders of the Hair and Nails
- Part 17 Disorders Due to the Environment
- Part 18 Psychosocial Skin Disease
- Part 19 Skin Changes across the Span of Life
- Part 20 Neoplasia
- Part 21 Metabolic, Genetic, and Systemic Diseases
- Part 22 Vascular Diseases
- Part 23 Bacterial Diseases
- Part 24 Fungal Diseases
- Part 25 Viral Diseases
- Part 26 Sexually Transmitted Diseases
- Part 27 Infestations, Bites, and Stings
- Part 28 Topical and Systemic Treatments
- Part 29 Physical Treatments
- Part 30 Dermatologic Surgery
- Part 31 Cosmetic Dermatology
最常考的考點
- 藥物光毒性/光過敏幾乎都由 UVA 引起(芳香族藥物吸收 UVA)UVA in drug-induced photosensitivity
- Carbamazepine SJS/TEN 與 HLA-B*15:02(漢人、東南亞;日韓歐洲不成立;非必要條件)Carbamazepine SJS/TEN and HLA-B*15:02
- PG 胎兒風險(small-for-gestational-age、早產)Pemphigoid gestationis: fetal risk
- UV 紅斑 action spectrum 高峰 300 nm(UVB);UVB 致紅性約 UVA 1000 倍Erythema action spectrum (UVB 1000x UVA)
- 急性 AD 以 Th2 細胞激素 IL-4、IL-13 為代表Acute AD Th2 cytokines (IL-4, IL-13)
- EM 多與感染相關,藥物不是常見病因EM etiology: mostly infection, rarely drugs
- Netherton syndrome 經皮吸收增加(外用 tacrolimus 可達全身毒性濃度、TCI 列為禁忌)Netherton syndrome: increased percutaneous absorption and topical tacrolimus/TCI risk
- Darier disease 致病基因(ATP2A2/SERCA2 鈣幫浦)Darier disease gene
- PF 自體抗原(Dsg1)Pemphigus foliaceus autoantigen
- PNP 自體抗原(desmoplakin I/II、envoplakin、periplakin)Paraneoplastic pemphigus autoantigens
- PNP 頑固性口腔炎:最早、最恆定、最抗治療;無口腔炎不列入鑑別PNP intractable stomatitis
- Vitiligo 合併自體免疫疾病(T1DM、autoimmune thyroiditis、pernicious anemia、Addison、SLE、alopecia areata;generalized 較多)Vitiligo autoimmune associations
- HS 典型分布(腋下最常見、鼠蹊、臀、會陰、乳房下)Hidradenitis suppurativa distribution
- HS 主要致病事件為 terminal hair follicle 角化阻塞(汗腺為續發受累)HS pathogenesis: follicular occlusion (sweat glands secondary)
- NCCN 部位分區與大小切點(Area H 不論大小;Area M ≥10 mm;Area L ≥20 mm)NCCN cSCC location/size risk areas (H/M/L)
- EMPD CK7/CK20 型態(primary 多 CK7+/CK20−;secondary 常 CK7+/CK20+)CK7/CK20 pattern in primary vs secondary EMPD
- Nail matrix 切片變形風險(punch ≤3 mm;越近端風險越高)Nail matrix biopsy and dystrophy risk
- 刺青顏色與雷射(黑:1064/755/694;紅/黃:532;藍綠:755/694;紫橘:532/755)Laser selection by tattoo ink color
- 未經評讀的專家意見為最低證據等級Expert opinion as lowest level of evidence
- RCT 以隨機分派與盲性降低 bias,為療效評估的 gold standard/最高層級單一研究RCT as highest-level single study design
- FLG null mutations 為 atopic dermatitis(及合併 AD 的 asthma)易感因子Atopic dermatitis: FLG susceptibility
- Immediate pigment darkening 主要 UVA(20 分鐘內);delayed tanning 主要 UVB(約 3 天)Tanning: IPD (UVA) vs delayed tanning (UVB)
- Oil spot/salmon patch 幾乎為乾癬特有Oil spot specificity for psoriasis
- 誘發 lichenoid drug eruption 的藥物(Table 32-2)Lichenoid drug eruption culprit drugs
- GA 與糖尿病的關聯(主要 type 1、較常見於 generalized/perforating GA;多數 GA 無糖尿病)Granuloma annulare and diabetes mellitus association
- SPD 對稱分布於腋下、鼠蹊、乳房下、腹部與四肢屈側SPD distribution
- SPD 頭皮與黏膜總是不受侵犯SPD spares scalp and mucosa
- SPD 治療(dapsone 首選;類固醇)SPD treatment
- EN 藥物風險分級(Table 44-3:高風險 allopurinol、sulfonamide、oxicam 等;diclofenac 中度;sulfonylurea、aspirin 非高風險)Epidermal necrolysis drug risk categories
- AGEP 常見藥物(β-lactam、macrolide、quinolone、抗癲癇藥、diltiazem、terbinafine)AGEP culprit drugs
- AGEP 特徵(急性發燒、neutrophilia、廣泛非毛囊性膿疱、用藥 24–48 小時內;無淋巴結腫大、無關節炎)AGEP features (incl. systemic features)
- Darier disease 肢端與掌蹠表現(手背 AKV 樣丘疹、palmar pits/keratotic papules、PPK;hemorrhagic macules 最少見)Darier disease acral and palmoplantar features
- Darier disease 指甲(nail fragility、疼痛縱裂、紅白縱紋、V-shaped nicks)Darier disease nail changes
- PNP 相關腫瘤(NHL、CLL、Castleman、thymoma)PNP associated neoplasms
- DH 首選 dapsone,數小時至數天見效,可作 therapeutic diagnosisDapsone for DH (rapid response)
- Dactylitis 與 enthesitis、nail–entheseal complexDactylitis, enthesitis and nail–entheseal complex
- PsA 眼部侵犯(conjunctivitis、uveitis 等)Ocular involvement in psoriatic arthritis
- Vitiligo 致病機轉(CD8+ T cells→IFN-γ→keratinocyte CXCL10→招募 T cells)Vitiligo pathogenesis: CD8+ T cell–IFN-γ–CXCL10 axis
- Vitiligo 病灶 leukotrichia/poliosis 代表毛囊儲備受損、治療反應差Leukotrichia and vitiligo prognosis
- Acne fulminans 治療(先類固醇 2–4 週,再低劑量 isotretinoin 0.1 mg/kg/day 起始)Acne fulminans treatment
- HS 與吸菸:危險因子、病情較重;戒菸改善症狀並減少術後新病灶HS and smoking
- Actinic prurigo 兒童期(<10 歲)發病、多女性(亞洲人男多)、青春期改善Actinic prurigo onset and demographics
- Erythema toxicum neonatorum 膿疱含大量 eosinophilsErythema toxicum neonatorum histopathology
- AEP 無胎兒風險(母胎預後極佳)Atopic eruption of pregnancy: no fetal risk
- ICP 胎兒風險(早產、產程胎兒窘迫、胎死;與膽酸濃度相關)Intrahepatic cholestasis of pregnancy: fetal risk
- Impetigo herpetiformis 胎兒風險(胎盤功能不全→死產、新生兒死亡)Pustular psoriasis of pregnancy: fetal risk
- Impetigo herpetiformis 好發第三孕期(最早可第一孕期),持續至生產Pustular psoriasis of pregnancy: trimester of onset
- AK 進展為 invasive SCC 的比例(整體約 5–10%;單一病灶每年 <1%)AK progression rate to SCC
- 免疫抑制(器官移植、CLL)為 SCC 高危險因子;心肺移植風險更高Immunosuppression as cSCC high-risk factor
- 發生於疤痕、慢性潰瘍/發炎或放療部位的 SCC 為高危險(轉移率 18–40%)cSCC arising in scars, chronic inflammation, or prior RT sites
- MCC 對放射線敏感:窄邊緣切除+輔助放療;不適手術者可單用放療Radiosensitivity and adjuvant RT in MCC
- GCDFP-15(apocrine 標記)primary EMPD 多陽性、secondary 多陰性GCDFP-15 in primary vs secondary EMPD
- KMP 幾乎只見於 tufted angioma 與 KHE,不發生於 IHTumors associated with Kasabach-Merritt phenomenon
- MF 早期好發非日曬部位(bathing trunk、皺摺處),可呈 poikilodermaMF predilection for sun-protected sites
- Acute GVHD 為 Th1、chronic GVHD 以 Th2 為主,Th17 兩者皆參與Th polarization in acute vs chronic GVHD
- 所有類型 KS(含 classic)皆有 HHV-8HHV-8 in all Kaposi sarcoma types
- Lyme disease 致病菌 Borrelia burgdorferi(Ixodes tick 傳播)Lyme disease pathogen
- Ustekinumab 標的(IL-12/23 p40)Ustekinumab mechanism
- DFSP 主要治療為完整手術切除(Mohs/切緣確認的 staged excision)DFSP primary treatment: complete surgical excision
- Pseudo-Darier sign(congenital smooth muscle hamartoma)Pseudo-Darier sign
- DFSP 免疫染色(CD34+、Factor XIIIa−;dermatofibroma 相反)DFSP immunohistochemistry vs dermatofibroma
- Eccrine 汗腺由交感節後 cholinergic 纖維支配,主要傳導物質為 acetylcholineEccrine gland innervation: sympathetic cholinergic
- Filaggrin 在角質層中層降解為 NMF,維持屏障與保水Filaggrin degradation to NMF and barrier
- Exfoliative toxin(exfoliatin A/B)造成 bullous impetigo 與 SSSS,切割 Dsg1Exfoliative toxins (ETA/ETB) cleave Dsg1 in bullous impetigo and SSSS
- UVA 在光老化扮演核心角色(Table 17-2)Central role of UVA in photoaging
- 光敏感反應經 photosensitized reaction 產生 singlet oxygen 等 ROSPhotosensitized reactions generate ROS
- AD 屏障缺陷(cornified envelope 基因下降、ceramide 減少、蛋白酶上升、TEWL 增加)Skin barrier dysfunction in AD
- 約 1/3 AD 有 filaggrin 缺乏表徵(IV、KP、hyperlinear palms)Clinical signs of filaggrin deficiency in AD
- 慢性 AD IL-5 增加,促 eosinophil 發育與存活IL-5 in chronic AD
- ACD 皮膚抗原呈現細胞(Langerhans cells、dermal DCs)Antigen-presenting cells in ACD
- ACD 致敏期約 10–15 天且通常無症狀ACD sensitization phase
- 致敏期淋巴結 naive T 分化為 memory/effector TT-cell differentiation in ACD sensitization
- 染髮劑 PPD 過敏性接觸性皮膚炎(常見致敏原;頭皮腫脹結痂、眼瞼水腫)PPD hair-dye allergic contact dermatitis
- Hapten 性質(<500 Da、親脂性)Hapten properties
- Contact urticaria 診斷(open、prick、短時間 patch、specific IgE;備 anaphylaxis 急救)Testing for contact urticaria
- Acitretin 懷孕禁忌(category X、停藥後 3 年)Acitretin in pregnancy
- Cyclosporine 懷孕 category C、無致畸性Cyclosporine in pregnancy
- MTX 懷孕禁忌(category X、致胎毒、墮胎)Methotrexate in pregnancy
- Lupus pernio 代表慢性破壞性病程(留疤、鼻中膈穿孔、肺纖維化),預後差需積極治療Lupus pernio: chronic destructive course and poor prognosis
- Sarcoidosis 胸部 X 光(hilar adenopathy 50–85%、>90% 異常)Chest radiograph in sarcoidosis
- Sarcoidosis 皮膚病灶分 specific(有肉芽腫)與 nonspecific(EN,無肉芽腫)Specific vs nonspecific cutaneous sarcoidosis
- Sweet syndrome 治療(系統性類固醇;KI、colchicine 為第一線)Sweet syndrome treatment
- Pustular PG 幾乎只見於急性 IBD 惡化,控制 IBD 有助緩解Pustular PG and IBD
- Vegetative PG 進展慢、多不合併系統疾病、預後佳Vegetative pyoderma gangrenosum
- IgE 上升只見於 KD,ALHE 正常Serum IgE in Kimura disease vs ALHE
- EPF 各型分布(classical 臉軀幹、20% 掌蹠;HIV 頭頸上軀幹近端四肢;infantile 頭皮)EPF distribution by subtype
- EPF 第一線治療(外用類固醇、TCI、indomethacin)EPF first-line treatment
- Cholinergic urticaria 約 2/3 對汗液抗原致敏(Malassezia globosa 的 MGL_1304)Cholinergic urticaria: sweat antigen MGL_1304
- Darier sign(mastocytosis,成人不一定明顯)Darier sign
- 復發性 EM 治療(抗 HSV 預防;azathioprine、thalidomide、MMF)Recurrent EM treatment
- EN:HLA-B*5801 與 allopurinolEpidermal necrolysis: HLA-B*5801 and allopurinol
- SCORTEN 七項指標SCORTEN items
- 藥物性痤瘡樣疹的藥物(lithium、isoniazid、glucocorticoids、高劑量 vitamin B 等)Drug-induced acneiform eruption culprits
- Pseudoporphyria 的致病藥物(naproxen、NSAIDs、diuretics)Pseudoporphyria culprit drugs
- Erythema migrans 為 Lyme disease(Borrelia)第一期皮疹Erythema migrans in Lyme disease
- Ichthyosis vulgaris 由 FLG 功能喪失突變造成Ichthyosis vulgaris: FLG mutations
- Netherton 毛幹異常(trichorrhexis invaginata/bamboo hair,IRS 角化異常、眉毛常見)Netherton syndrome: trichorrhexis invaginata
- Netherton syndrome:SPINK5/LEKTI 缺乏致 KLK 過度活化、過度脫屑Netherton syndrome: SPINK5/LEKTI
- Striate PPK 的致病基因(DSG1、DSP)Striate palmoplantar keratoderma genes
- KP 發病年齡與年齡別分布(幼童臉/手臂;青少年成人四肢伸側;無 old-age 型)Keratosis pilaris onset age and age-specific distribution
- Keratosis pilaris 好發部位(臉頰、上臂伸側、大腿、臀;會侵犯臉部)Keratosis pilaris distribution
- Hailey-Hailey disease 致病基因(ATP2C1/SPCA1 鈣幫浦)Hailey-Hailey disease gene
- 藥物性天疱瘡的主要藥物(thiol:penicillamine、captopril)Drug-induced pemphigus: culprit drugs
- Rituximab 作用機轉(anti-CD20、B 細胞耗竭)Rituximab mechanism (anti-CD20)
- PNP defining features(疼痛性口炎+多形性皮疹)PNP defining features
- PNP DIF:細胞間 IgG/C3 ± BMZ 沉積,偽陰性較 PV 常見、需重複切片PNP direct immunofluorescence
- PNP 腫瘤切除後的病程(良性/包被性腫瘤完全切除可緩解;惡性腫瘤治療不影響)PNP course after tumor resection
- 藥物性 BP 的誘發藥物(furosemide、ACE inhibitors、penicillins、etanercept、anti-PD-1、DPP4 inhibitors 等)Drug triggers of bullous pemphigoid
- EBA 自體抗原(collagen VII)EBA autoantigen
- IgA pemphigus 自體抗原(SPD 型 Dsc1;IEN 型 Dsg1/Dsg3)IgA pemphigus autoantigens
- Morphea 無 acrosclerosis/sclerodactyly(與 SSc 區分)Absence of sclerodactyly in morphea
- csDMARDs 對 enthesitis 與 axial PsA 無效,第一線為 TNF inhibitorcsDMARDs ineffective for axial PsA/enthesitis
- Erythema nodosum 病因(鏈球菌、藥物如口服避孕藥、惡性腫瘤、TB)Erythema nodosum etiologies
- Phenols(monobenzone、4-tert-butyl phenol)結構類似 tyrosine 而誘發脫色Phenol-induced vitiligo
- Vitiligo 疾病活性徵象(Koebner、trichrome、confetti-like、inflammatory lesions)Vitiligo activity signs
- Vitiligo 治療反應與部位(臉等有毛處佳;glabrous/acral 處差)Vitiligo response by body site
- Wood lamp 於色素減少疾病鑑別(tinea versicolor 黃綠螢光;pityriasis alba 無螢光、不增強)Wood lamp in hypopigmentation differential
- Nevus of Ota 治療首選 QS lasers(ruby、alexandrite、Nd:YAG)Nevus of Ota: Q-switched laser
- 口服 retinoid(isotretinoin 等)致畸與避孕:育齡女性需避孕;不影響男性精子,男性不需避孕或停藥Systemic retinoid teratogenicity and contraception (no effect on male fertility)
- Isotretinoin 併用 tetracyclines 增加 pseudotumor cerebri 風險Isotretinoin + tetracycline: pseudotumor cerebri
- Rosacea 一般處置(避開誘發因子、防曬、皮膚照護)適用所有亞型Rosacea general measures for all subtypes
- Rosacea 口服 isotretinoin(低劑量,phymata、Morbihan)Isotretinoin for rosacea
- Rosacea 誘發因子(日曬、熱、冷、風、運動、辛辣、酒精、壓力)Rosacea triggers
- 多汗症第一線外用 aluminum chloride hexahydrate 10%–35%(睡前塗於乾燥皮膚、6–8 小時後洗掉)Aluminum chloride hexahydrate as first-line topical therapy
- HS 長期病灶併發 SCC(約 4.6%、少見、局部侵犯性強、淋巴轉移率高)SCC complicating HS
- HS 生物製劑(adalimumab FDA 核准 first-line;infliximab 用於 adalimumab 無效者)TNF inhibitors for HS (adalimumab, infliximab)
- 藥物性 TE(Table 86-2:vitamin A/retinoids、oral contraceptives 等)Drug-induced TE
- TE 機轉:anagen 提早結束轉入 telogen(毛髮大小正常、無 miniaturization)TE mechanism: premature anagen termination
- TE 為非疤痕性、可逆/自限的落髮Telogen effluvium: nonscarring, reversible
- 杵狀指病因(Table 91-8:肺、心血管含 aortic aneurysm、先天心臟病、methemoglobinemia 等)Causes of digital clubbing
- 外源性光敏感分 phototoxicity 與 photoallergyExogenous photosensitivity: phototoxicity vs photoallergy
- Frostbite 治療為快速回溫(37–39°C 水浴);慢回溫使冰晶變大Frostbite: rapid rewarming
- Opiates 直接使 mast cell 釋放 histamine(urticaria、angioedema、heroin high pruritus)Opiate histamine release: urticaria and pruritus
- 菸草與尼古丁(含電子煙)收縮血管、妨礙傷口癒合;建議術前術後各至少停用 1 週Tobacco/nicotine impairs wound healing
- Aplasia cutis congenita 可為 NTD forme fruste、可能顱內連通,切片/刮取前須影像Aplasia cutis congenita and cranial dysraphism
- 中線(鼻部)dermoid cyst 可顱內延伸(最多 25%),切片前應 MRIMidline dermoid cyst: intracranial extension
- ETN 2–3 週自行消退、不留痕跡ETN course
- ETN 見於最多 75% 足月兒、早產兒罕見ETN: term vs preterm infants
- Impetigo herpetiformis 產後症狀迅速緩解(cardinal feature)Pustular psoriasis of pregnancy: postpartum resolution
- Impetigo herpetiformis 後續懷孕常復發、更早更重Pustular psoriasis of pregnancy: recurrence
- Impetigo herpetiformis 治療(系統性類固醇為過去主力;9e:cyclosporine、infliximab 一線)Pustular psoriasis of pregnancy: treatment
- PEP 無胎兒風險Polymorphic eruption of pregnancy: no fetal risk
- 慢性砷暴露皮膚癌常多發(arsenical keratoses、Bowen disease、superficial BCC、SCC)Arsenic-associated skin cancers
- >60% 皮膚 SCC 源自既有 AKProportion of SCC arising from AK
- NCCN 分化程度:poorly differentiated 為高危險;well/moderately 為低危險NCCN differentiation risk in cSCC
- MCC 免疫染色(CK20+ perinuclear dot、TTF-1−、S-100−、LCA−;10–20% CK20 陰性)MCC immunohistochemistry
- 血清 CEA 上升的 EMPD 死亡風險高,CEA 與病程平行、可用於追蹤Serum CEA in EMPD prognosis and surveillance
- MUC2 primary EMPD 陰性,伴大腸直腸腺癌的 secondary EMPD 可陽性MUC2 in EMPD
- BRAF 突變分布(SSM/NM、間歇日曬皮膚最高;acral、mucosal 低)BRAF mutation frequency by melanoma subtype
- 原發 melanoma 不建議常規 CT/MRI/PET(偽陽性 8–15%);Breslow ≥4 mm 或已知轉移才考慮Imaging workup in primary melanoma