107.2 📚 國考版醫垫國考 / PGY OSCE

107.2.0.1 📌 Cram Sheet

107.2.0.1.1 🔥 高 yield 12
  1. AA: pancytopenia + hypocellular BM + no fibrosis/clonal
  2. AA causes: idiopathic > drug (chloramphenicol/NSAID/AED/methimazole) > viral (hepatitis non-A-E) > toxin (benzene) > radiation
  3. SAA Camitta: 2 of 3 (ANC < 500, plt < 20K, retic < 1%) + BM < 25%
  4. AA Tx: HSCT (< 50 + MSD) OR ATG + cyclosporine + eltrombopag
  5. Eltrombopag added IST (NEJM 2017): improved response
  6. MDS: cytopenia + dysplasia (≥ 10%) + cytogenetic/molecular
  7. IPSS-M (2022): integrates 31 mutations
  8. del(5q): lenalidomide 60-70% TI
  9. SF3B1+/RS: luspatercept (FDA expanded 2023)
  10. Higher-risk MDS: AZA/decitabine ± venetoclax; HSCT curative
  11. Imetelstat (Rytelo, FDA 2024) for refractory transfusion-dep MDS
  12. Fanconi: DEB test; thumb/radius/café-au-lait + AA + H/N SCC
107.2.0.1.2 🔢 必背
項目 æ•žå­—
SAA ANC < 500
SAA plt < 20K
SAA retic < 1%
SAA BM cellularity < 25%
vSAA ANC < 200
MDS dysplasia threshold ≥ 10% in 1+ lineage
del(5q) lenalidomide TI 60-70%
AZA response ~ 50%
MDS to AML 30%

107.2.0.2 ⭐ 高 yield

107.2.0.2.1 MDS WHO 2022 Subtypes
Subtype Feature
MDS-LB (low blast) < 5% blasts
MDS-RS Ringed sideroblasts + SF3B1
MDS-5q− del(5q); lenalidomide-responsive
MDS-IB1 5-9% blasts
MDS-IB2 10-19% blasts
MDS-TP53 mutation Poor prognosis; AML risk
MDS-f (fibrosis) Poor
107.2.0.2.2 MDS Drugs Quick
Drug Mechanism Indication
ESA (epoetin) EPO Lower-risk; EPO < 500
Lenalidomide Anti-clonal del(5q)
Luspatercept (Reblozyl) TGF-β inhibitor SF3B1/RS; expanded 2023 to all lower-risk
Azacitidine (Vidaza) HMA Higher-risk; ORR + OS benefit
Decitabine (Dacogen) HMA Higher-risk
Venetoclax + AZA BCL-2 + HMA Higher-risk newer
Imetelstat (Rytelo) Telomerase Transfusion-dependent refractory (FDA 2024)
HSCT Replace clone Curative; younger fit
107.2.0.2.3 Hereditary BMF Syndromes
Syndrome Gene Key Features
Fanconi FANC Thumb/radius, café-au-lait, AA, AML/H&N SCC
Dyskeratosis congenita TERC, TERT, TINF2 Nail dystrophy + leukoplakia + skin pigment
Diamond-Blackfan RPS19, RPL5 Pure red cell aplasia (newborn)
Shwachman-Diamond SBDS Pancreatic insufficiency + BMF
Severe congenital neutropenia ELANE Kostmann; severe neutropenia
CAMT MPL Amegakaryocytic thrombocytopenia
107.2.0.2.4 AA Drug Causes (Memorize)
  • Chloramphenicol (classic)
  • NSAID
  • Antiepileptic (phenytoin, carbamazepine)
  • Gold
  • Sulfonamide
  • Methimazole/PTU
  • Dapsone

107.2.0.3 🎯 自我檢枬

  1. SAA Camitta criteria? → 2 of 3: ANC < 500, plt < 20K, retic < 1% + BM < 25%
  2. AA Tx age < 50 + MSD? → HSCT
  3. AA without MSD/older? → ATG + cyclosporine + eltrombopag
  4. AA classic drug? → Chloramphenicol
  5. AA viral? → Non-A-E hepatitis
  6. MDS criteria? → Cytopenia + dysplasia ≥ 10% + cytogenetic/molecular
  7. del(5q) drug? → Lenalidomide
  8. SF3B1/RS drug? → Luspatercept
  9. Higher-risk MDS 1st? → Azacitidine ± venetoclax
  10. Refractory MDS 22E? → Imetelstat (Rytelo)
  11. MDS to AML rate? → 30%
  12. Fanconi test? → DEB chromosomal fragility
  13. Diamond-Blackfan? → Pure red cell aplasia (newborn)
  14. Dyskeratosis congenita triad? → Nail dystrophy + leukoplakia + skin pigment
  15. Shwachman-Diamond? → SBDS + pancreatic insufficiency + BMF

⚠ AI 草皿。