104.3 🩺 內科專科考前版

104.3.0.1 📌 䞀頁重點

  • 22E: oral B12 high-dose for pernicious anemia (alternative to IM); MMA gold for B12 def confirmation; pregnant + AED 4-5 mg folate; pernicious anemia endoscopic surveillance for gastric CA + carcinoid
  • Taiwan: 健保 cyanocobalamin IM/SC + oral B12; 健保 folic acid; 健保 leucovorin (MTX rescue + chemo); 健保 endoscopy for pernicious anemia screening 條件

104.3.0.2 🌟 Pearls (8)

  1. Oral B12 1000-2000 ÎŒg/d as effective as IM for pernicious anemia (Cochrane 2018+)
  2. Hydroxocobalamin preferred over cyanocobalamin in some countries (longer half-life + retention)
  3. Methylcobalamin / adenosylcobalamin active forms (oral); benefit unclear vs cyano
  4. Pernicious anemia + gastric carcinoid: 3-5x baseline; endoscopy in selected
  5. Vitamin B12 deficiency neuro recovery: variable; chronic deficiency (years) → permanent damage
  6. Combined B12 + folate def: treat both; B12 first
  7. Hyperhomocysteinemia + CV risk: not reduced by B12/folate supplementation in trials (HOPE-2, NORVIT, VISP)
  8. Pyridoxine (B6) deficiency: rare but causes microcytic / sideroblastic; not megaloblastic

104.3.0.3 📍 Taiwan + 健保

  • 健保 cyanocobalamin IM/SC injectable
  • 健保 oral B12 (multiple)
  • 健保 folic acid PO
  • 健保 leucovorin (folinic acid) for MTX rescue + chemo support
  • 健保 anti-IF + anti-parietal Ab 條件
  • 健保 MMA + homocysteine 條件 (新, 限制)
  • 健保 EGD for pernicious anemia surveillance 條件
  • 孞會: TSH (Taiwan Society of Hematology) + Taiwan Society of Internal Medicine

104.3.0.4 🎓 內專必懂 (8)

  1. B12 absorption pathway 4 steps + each disruption
  2. MMA + homocysteine interpretation
  3. Pernicious anemia + endoscopic surveillance
  4. Oral vs IM B12 evidence
  5. Folate pregnancy + AED dosing
  6. MTX rescue with leucovorin
  7. Macrocytic without anemia differential
  8. Drug-induced B12/folate causes

⚠ AI 草皿。