102.2 📚 國考版醫垫國考 / PGY OSCE

102.2.0.1 📌 Cram Sheet

102.2.0.1.1 🔥 高 yield 12
  1. MCV-based 分類: micro (< 80) / macro (> 100) / normo
  2. IDA: ferritin < 30 + Tsat < 16% + TIBC ↑
  3. ACD: Tsat ↓ + ferritin normal/high
  4. Adult男/postmen女 IDA → colonoscopy mandatory
  5. Oral iron alternate-day > daily (Cochrane 2019)
  6. IV iron: malabsorption, IBD, CKD, pregnancy, intolerance
  7. Plummer-Vinson: IDA + dysphagia + esophageal web (SCC risk)
  8. CKD anemia: ESA + iron + HIF-PHI (22E)
  9. Hb target CKD: 10-11.5 (avoid > 11.5; TREAT trial)
  10. Sideroblastic: ringed sideroblasts + B6 trial
  11. Drug-induced sideroblastic: isoniazid, chloramphenicol, linezolid, alcohol
  12. Daprodustat / vadadustat / roxadustat = HIF-PHI 22E
102.2.0.1.2 🔢 必背
項目 æ•žå­—
MCV micro < 80
MCV macro > 100
Ferritin IDA < 30 ng/mL
Tsat IDA < 16-20%
Hb target CKD 10-11.5 g/dL
Ferrous sulfate elemental 65 mg per 325 mg tablet
Iron replacement duration 3-6 mo after Hb normalize
Alternate-day dose Q-other-day (Cochrane 2019)

102.2.0.2 ⭐ 高 yield

102.2.0.2.1 IDA vs ACD vs Combined
IDA ACD Combined
Ferritin < 30 normal/↑ < 100
Tsat < 16% low low
TIBC ↑ ↓ varies
Hepcidin ↓ ↑ varies
102.2.0.2.2 Drug Causing Sideroblastic
  • Isoniazid
  • Chloramphenicol
  • Linezolid
  • Busulfan
  • Alcohol
  • Copper deficiency (zinc excess)
  • Lead
102.2.0.2.3 IV Iron Formulations
Drug Single dose Notes
Iron sucrose 100-300 mg Multiple doses
Ferric gluconate 125-250 mg Multiple
Ferric carboxymaltose 750-1000 mg Single; hypophosphatemia
LMW iron dextran 1000 mg Single (test dose first)
Ferric derisomaltose 1000 mg Single
Ferumoxytol 510 mg Cardiac MRI artifact
102.2.0.2.4 CKD Anemia Drugs (22E)
  • Roxadustat — first HIF-PHI; China + EU
  • Vadadustat — FDA 2023; CKD on dialysis
  • Daprodustat — FDA 2023; CKD dialysis
  • Enarodustat, molidustat — Asia approvals
102.2.0.2.5 Plummer-Vinson Triad
  • Iron-deficiency anemia
  • Dysphagia
  • Esophageal web
  • → Post-cricoid SCC risk

102.2.0.3 🎯 自我檢枬

  1. MCV micro causes? → IDA, thalassemia, ACD (adv), sideroblastic, lead
  2. IDA ferritin? → < 30 ng/mL
  3. ACD ferritin? → Normal or high
  4. Adult IDA workup? → Colonoscopy mandatory
  5. Oral iron dosing 22E? → Alternate-day
  6. IV iron indication? → Malabsorption, CKD, IBD, pregnancy
  7. Plummer-Vinson? → IDA + dysphagia + esophageal web → post-cricoid SCC
  8. Sideroblastic test? → BM ringed sideroblasts
  9. ALAS2 mutation? → Hereditary sideroblastic, B6-responsive
  10. Drug-induced sideroblastic? → Isoniazid, chloramphenicol, linezolid
  11. CKD anemia Hb target? → 10-11.5
  12. HIF-PHI examples? → Roxadustat, vadadustat, daprodustat
  13. Hepcidin ↑ in? → Inflammation
  14. Iron + Vit C? → Vit C enhances absorption
  15. IBD anemia? → IV iron preferred (avoid oral GI worsening)

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