21 一位13歲男童因肉眼可見之血尿（gross hematuria）、下肢皮膚紅疹（skin rash）及腹痛入院。他在過去1年當中曾經因為相同的症狀反覆住院3次。他最可能的診斷是：

全身性紅斑性狼瘡合併狼瘡性腎炎（lupus nephritis）

IgA腎炎（IgA nephropathy）

Henoch-Schönlein紫斑症（Henoch-Schönlein purpura）

家族性薄基底膜疾病（familial thin basement membrane disease）

ANS HSP

Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis characterized by purpura, arthritis, abdominal pain, and hematuria

Pathophysiology

Henoch-Schönlein purpura (HSP) is a small-vessel vasculitis characterized by immunoglobulin A (IgA), C3, and immune complex deposition in arterioles, capillaries, and venules. HSP and IgA nephropathy are related disorders. Both illnesses have elevated serum IgA levels and identical findings on renal biopsy; however, IgA nephropathy almost exclusively involves young adults and predominantly affects the kidneys only. HSP affects mostly children and involves the skin and connective tissues, gastrointestinal tract, joints, and scrotum as well as the kidneys.^2,3,4

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23 一位2個月大的女嬰今早因尿布上有紅尿（如圖）至急診求診。女嬰母親主訴過去一天母乳餵哺狀況良好。身體檢查發現女嬰除有輕微皮膚黃外，精神活力良好。尿液常規檢查顯示bilirubin：陰性(-); urobilinogen：陰性(-); occult blood：陰性(-); protein：陰性(-); WBC 0-2/HPF; RBC 0-2/HPF。下列何者為其最可能之診斷？

 急性肝炎（acute hepatitis）

急性溶血（acute hemolysis）

尿酸結晶（urates）

紫質（porphyrin）

ANSWER URATES

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25 有關新生兒身體檢查，下列敘述何者錯誤？

兩手臂成不對稱伸張之驚嚇反射（Moro reflex），要考慮是否有臂神經叢（brachial plexus）受損

乳頭分泌乳汁，是受母體激素影響所致

頭部頭血腫（cephalohematoma），應用減菌針頭吸取積血以免造成壓迫

頭部產瘤（caput succedaneum）通常自動消失不須治療