[{"data":1,"prerenderedAt":64},["ShallowReactive",2],{"q-nurse-107-1-basic-medicine-071":3},{"subject":4,"subjectSlug":5,"subjectFullName":6,"question":7,"related":33,"lastmod":63},"基礎醫學","basic-medicine","基礎醫學(包括解剖學、生理學、病理學、藥理學、微生物學與免疫學)",{"id":8,"webId":9,"year":10,"session":11,"subject":4,"number":12,"stem":13,"options":14,"answer":19,"answerNote":20,"images":21,"explanation":22,"explanationDeep":23,"topics":24,"freq":11},"nurse-107-1-基礎醫學-071","nurse-107-1-basic-medicine-071",107,1,71,"抗 methicillin 金黃色葡萄球菌（MRSA）之抗藥性機制為何？",{"A":15,"B":16,"C":17,"D":18},"使用替代的代謝途徑","核糖體結構改變","產生 β-lactamase 分解 methicillin","細菌染色體突變造成青黴素結合蛋白（PBPs）構造改變","D",null,[],"本題考點為 MRSA 對 methicillin 抗藥性的分子機制。依微生物學,β-lactam 抗生素靠結合細菌的青黴素結合蛋白（PBPs，即細胞壁交聯的轉肽酶）而抑制細胞壁合成;MRSA 帶 mecA 基因,製造低親和力的 PBP2a,使 methicillin 無法有效結合、細胞壁照常合成而抗藥,故選 D。A 錯,繞道另一代謝途徑是磺胺類抗藥概念。B 錯,核糖體結構改變是對胺基醣苷、四環黴素等蛋白質合成抑制劑的抗藥機制,與作用於細胞壁的 methicillin 無關。C 錯,methicillin 本就設計為耐 β-lactamase,故 MRSA 抗藥不靠此酶。","關鍵記憶點:mecA→PBP2a→低親和力,是 MRSA 的招牌機轉。可對比 penicillinase-producing S. aureus(靠 β-lactamase 水解普通 penicillin,故發展出耐酶的 methicillin\u002Foxacillin);而 MRSA 更進一步改造靶點本身,連 methicillin 也無效,治療須改用 vancomycin。四種抗藥大類機制可整理成表:①改造靶點(PBP2a、核糖體 methylation)②產生水解酶(β-lactamase)③降低通透性\u002F外排幫浦 ④代謝旁路(磺胺)。本題四選項恰好各對應一種機制,答對的關鍵是認得 methicillin 屬「耐酶但怕靶點改變」。",[25,27,29,31],{"term":26,"count":11},"mecA 基因",{"term":28,"count":11},"PBP2a(青黴素結合蛋白)",{"term":30,"count":11},"β-lactam 抗生素作用機制",{"term":32,"count":11},"MRSA 抗藥機制",[34,38,43,48,53,58],{"webId":35,"stem":36,"number":37,"year":10,"session":11},"nurse-107-1-basic-medicine-072","下列何項病原菌並非經過水來傳播？",72,{"webId":39,"stem":40,"number":41,"year":42,"session":11},"nurse-108-1-basic-medicine-008","下列何者的靜脈血，不經由肝門靜脈進入肝臟？",8,108,{"webId":44,"stem":45,"number":46,"year":42,"session":47},"nurse-108-2-basic-medicine-022","包圍周邊神經軸突的髓鞘（myelin sheath），主要組成為何？",22,2,{"webId":49,"stem":50,"number":51,"year":52,"session":47},"nurse-109-2-basic-medicine-060","Cimetidine抑制胃酸分泌的藥理作用，為下列何種機轉？",60,109,{"webId":54,"stem":55,"number":56,"year":57,"session":11},"nurse-111-1-basic-medicine-024","下列有關微血管及組織液交換的敘述，何者錯誤？",24,111,{"webId":59,"stem":60,"number":61,"year":62,"session":47},"nurse-112-2-basic-medicine-038","下列何種避孕方式最適合用於年齡大於 35 歲且有抽菸習慣之女性？",38,112,"2026-09-04",1788510701570]